In 2009, state legislators in Massachusetts were facing a large budget gap and rising health care costs. After reviewing a number of choices, they opted to trim state subsidized health coverage for legal immigrants who have not been naturalized as citizens. Since the federal government doesn’t share the cost of care for this group, lawmakers reasoned, the state was justified in scaling back its commitment. Health Law Advocates sued, arguing that legal immigrants are entitled to the same health care benefits as citizens are. On Thursday, in a unanimous decision, the Massachusetts Supreme Judicial Court agreed.

“It is a wonderful day in the Commonwealth of Massachusetts. Justice has prevailed,” says Amy Whitcomb Slemmer, the executive director at Health Care for All.

Legal immigrants are also celebrating. The insurance plan the state created just for them limited where they could get care, had higher co-pays and fewer benefits. Hector Brito and his wife Cesario Reynoso ended up almost $3,000 in debt for lab tests and appointments that weren’t covered.

“This is a relief for me and everybody now,” says Brito. “They know” continues Brito, referring to other legal immigrants, “that in the future they don’t have that kind of problems. They will be covered.”

Well, maybe. Gov. Deval Patrick’s administration estimates the minimum cost of adding 40,000 people to the state’s subsidized insurance plan at $150 million a year. State tax revenues aren’t meeting expectations because of the economic downturn, so finding the money will be difficult.

The state has a several choices: It can look at new taxes or fees to fund coverage for legal immigrants. It can cut other programs. Or it can make subsidized insurance less generous for everyone. Jay Gonzalez, the state’s secretary for administration and finance, says he hopes that won’t happen, but it’s an option he can’t rule out.

“The place we’re at right now,” says Gonzalez, pausing, “is needing to weigh all those options, assess them and come to some decisions.”

Gonzalez is putting the final touches on the fiscal year 2013 budget that Patrick will file in a few weeks. It will have to include coverage for legal immigrants.

One large lingering question is: Will this decision that legal immigrants are entitled to the same health benefits as full citizens affect other government assistance programs that treat legal immigrants and citizens differently?

Gonzalez says “our lawyers are looking at this decision and what the potential impacts might be if it were applied to other places, but the direct impact is on providing health insurance. That’s the immediate challenge we have now, the one we have to face.”

It will be several months at least before these immigrants are enrolled in Commonwealth Care. The decision does not apply to illegal immigrants who are not eligible for state subsidized insurance. If the Affordable Care Act is still in place in 2014, there will be some federal assistance for coverage for legal immigrants.

– Provided by Kaiser Health News.

The lesser known proposal would encourage people to purchase insurance by giving them tax credits or deductions. Those who don’t buy insurance and need care would get it through hospitals and clinics serving the poor, which would receive subsidies not claimed by individuals.

Gingrich has “explored [the idea] and is generally supportive of it,” David Merritt, a campaign adviser, said in an interview. In March, Gingrich asked the author of the concept, conservative think tank president John Goodman, to explain it at an event sponsored by the Center for Health Transformation, a collaboration of public and private sector leaders that Gingrich founded in 2003.

But Gingrich hasn’t promoted the idea in his campaign. While his website offers support for tax credits or deductions to purchase private insurance, an approach popular among some conservatives, it doesn’t mention subsidies for so-called safety-net hospitals to care for the uninsured.

The latter proposal raises several important questions, says Alan Weil, executive director of the National Academy for State Health Policy, a nonpartisan organization that works with states on health policy issues. To begin with, which hospitals and clinics would receive the federal subsidies to treat the uninsured?

While some hospitals are publicly owned and serve a high proportion of indigents, many first-rate urban teaching hospitals also treat a lot of poor patients. “They are doing the highest-end clinical trials and using the newest techniques, but they are treating every medical problem that walks in the door,” said Weil.

Other issues would have to be addressed, Weil says, including how to deal with the health needs of illegal immigrants who almost certainly wouldn’t receive tax credits. Another would be determining the amount of the tax credit since older people pay more for insurance because medical spending generally increases with age.

Goodman, who heads the National Center for Policy Analysis in Dallas, offers some details. While he isn’t an official Gingrich adviser, he has been talking to Gingrich about health care for more than two decades, and worked with him in the early’90s to get Congress to promote medical savings accounts, which preceded health savings accounts.

“Newt has been a fan of Goodman for a long time, going back to his advocacy of health savings accounts,” Merritt said. “They agree on pretty much all of the issues and they’ve swapped some ideas.”

Goodman would restructure tax incentives for health insurance. Currently, both employers and employees get tax breaks for employer-sponsored group health insurance, but individuals who buy policies on their own do not. He would scrap that system and instead make available to every individual a refundable tax credit to purchase insurance. The subsidy would be the same for everyone, regardless of age, income or health status.

Goodman envisions a credit of about $7,000 per family to buy basic, catastrophic coverage. An individual, or an employer, could kick in more money to obtain richer benefits. If a health plan costs less than the subsidy, the person could keep the after-tax savings, after taxes.

For individuals who declined to use the tax credit to buy insurance, the federal government would redirect the subsidy to help fund safety net institutions, which would then care for the uninsured.

“If you turn us down and decide to be uninsured, we take the credit that would have gone to you and put it in a safety net,” Goodman said at the March event. “We’re not going to let you go without care, and the safety net is not as attractive as private sector medicine. But the government makes a commitment to the people. If you want insurance, we put the money there. If you want to be in a safety net, we put the money there.”

Sitting on the panel with Goodman, Gingrich stressed the importance of providing access to care to as many people as possible. “It’s much easier to guarantee access to care than it is to guarantee insurance,” Gingrich said. “You can design a system that pays for emergency rooms and community health centers. You can guarantee every American gets care. What gets expensive is guaranteeing that every American is going to go to the most expensive place in America, for the most expensive treatment, at their convenience, when they feel like it.”

Giving individuals greater power to make purchasing decisions will only work, however, if the government makes it easier for people to buy coverage in the individual insurance market, said Merritt. For those who have been unable to get affordable insurance because of poor health, Gingrich wants to improve the state network of high-risk pools used by people who have been turned down for individual policies.

“If you put everyone in the same market, it raises premiums for everyone,” Merritt said. “High-risk pools are a way of providing coverage without raising premiums for everyone else.” Under the health law, high-risk pools are phased out after 2014, when individuals will be able to purchase health insurance through state exchanges.

Merritt says to expect more detailed health proposals if Gingrich becomes the Republican presidential nominee. “It’s hard to be focused on health care when the focus has been on jobs and the economy,” he said.

– Provided by Kaiser Health News.

Washiington, DC, United States (KaiserHealth) – Autism treatment advocates have won one legislative battle after another since 2007, most recently in California, which sent a bill to the governor this month mandating that insurers cover the disorder. Now more than half the states have such requirements, but that success could be in jeopardy as federal officials set new national standards for health coverage.

Insurers and employers argue that the laws increase health costs because treatment is often expensive and lasts years. But the advocates have prevailed by using federal data showing a growing number of children with the disorder, compelling stories about middle-class families struggling to afford treatment and testimony from celebrity parents of children with autism, including former pro football stars Dan Marino and Doug Flutie.

However, a provision in the 2010 health overhaul law gives the federal government authority to define “benefits” that will be offered on the health insurance exchanges, or marketplaces, to individuals and small businesses starting in 2014. If states mandate a benefit, but it isn’t on the federal list, the states would be responsible for the cost of the coverage.

As a result, autism benefits and dozens of other state-required benefits, covering services and conditions such as infertility, acupuncture and chiropractic care, could be at risk. By the end of September, the Institute of Medicine is scheduled to recommend criteria the Department of Health and Human Services should use in determining the essential benefits package. HHS is expected to announce its decision by the end of the year.

“We do think states will be under enormous pressure to repeal benefits” not deemed essential, said Stephen Finan, senior director of policy for the American Cancer Society’s Cancer Action Network. The society is concerned that the benefits package will not include all the cancer screenings that it has recommended.

“It will be a new day,” said Amanda Austin, a lobbyist for the National Federation of Independent Business, which typically fights new insurance mandates because the costs will lead to higher premiums.

HHS faces a difficult balancing act: The more comprehensive the benefits package, the more it would cost insurers and their customers. Taxpayers would pay more, too, because the law provides government subsidies to help millions of people afford coverage.

Tens Of Thousands Of Dollars In Services

Most of the state laws covering autism require insurers to pay for behavioral analysis as well as physical and occupational therapy. These services can cost tens of thousands of dollars a year, although many states put dollar limits on coverage.

Autism encompasses many disorders ranging from mild to severe that can affect a child’s behavior and ability to communicate. Applied behavioral analysis typically involves one-on-one counseling to teach children how to behave or act in different situations. Although parents and many clinicians consider it the most effective therapy for children with autism, the results are mixed in peer-reviewed research.

Insurers typically oppose state benefit mandates, saying they reduce their ability to control costs. In addition, they argue that autism is a development disorder that is best addressed by the educational system, not the medical system.

Parents worry the essential-benefits provision could reopen the debate over covering treatment for autism and spark another showdown with insurers.

“Fear runs through my mind,” said Ann Rounseville of Newton, Mass., whose son Luke, 4, has been able to get speech, occupational and behavioral therapy because of the insurance benefit that started this year.

“Without this coverage he would not be getting any of the extra therapy he needs,” said Rounseville, estimating the Massachusetts law has saved her family more than $10,000 since May.

Stuart Spielman, a lobbyist for Autism Speaks, the New York-based group that has led the push for coverage laws, said he’s confident HHS will include autism because the federal law lists behavioral health treatment in its broad outline of what should be considered essential. The law also spells out the need for emergency services, hospitalization, maternity care, prescription drugs and prevention.

It’s unclear how HHS will decide what to deem an essential benefit. The agency could declare a broad list of categories of treatments and services essential and leave the specifics to the states.

At the state level, autism treatment advocates have argued that the problem is too big – and too expensive for families – not to be covered by insurers. They also say providing treatment to young children can save money in the long run by reducing the later need for institutionalized care.

The state mandate laws typically only affect about half of people with health coverage because they do not apply to self-insured employers, typically large companies.

1 In 110 Children Affected

According to the federal Centers for Disease Control and Prevention, 1 in 110 American children have been diagnosed with Autism Spectrum Disorder, including 1 in 70 boys. A Harvard University study in 2006 found that on average the annual care for a person with autism runs about $29,000 for medical costs and $38,000 for non-medical costs such as special education, camps and child care.

“The mandates have been a way for states to be doing something on a major issue without money coming out of the state treasury,” said Jack Pitney, professor of American politics at Claremont McKenna College in California. “It’s a cost borne by insurance companies who are not an object of a great deal of public affection.”

Insurers argue that the cost of autism coverage gets passed on to all their customers through higher premiums. The Council for Affordable Health Insurance, an insurer-backed group, estimates that autism mandates boost premiums from 1 percent to 3 percent.

Highmark, Pennsylvania’s largest private health insurer, says the autism mandate enacted in the state in 2009 increased premiums from 0.6 to 1 percent. Overall, the cost of employer-paid insurance for family coverage last year was $13,770, according to a Kaiser Family Foundation study. (Kaiser Health News is an editorially independent part of the foundation.)

Autism advocates point to lower estimates. They say data from the agency overseeing health benefits for South Carolina state employees shows that autism coverage added just 44 cents per member per month.

Richard Cauchi, program director of the health program of the National Conference of State Legislatures, said HHS has not yet said how it will determine the cost to states of keeping certain mandates. States may be required to pay the insurer or the enrollee.

Cauchi was surprised 16 states approved a variety of new mandates in 2011 given the uncertainty about future costs. Four of the states imposed autism benefits: Arkansas, Rhode Island, Virginia and West Virginia.

Until 2007, only Indiana required insurers to cover autism treatment. Today, 26 states do, not including California, where Gov. Jerry Brown (D) has not yet said if he will sign the bill, and New York, where a bill awaits the signature of Gov. Andrew Cuomo (D).

Autism advocates and other patient groups continue to press for more benefits laws. By 2014, Cauchi said, “There could certainly be a number of mismatches between what’s considered essential and what states have on their books.”

Wilson Cristancho of Miami hopes the autism treatment Florida requires remains part of his insurance. Before the law took effect in 2009, he said he piled up nearly $30,000 in debt for his son’s medical bills. The intensive therapy now paid for by his insurer has helped his son, Marc Anthony, 9, communicate and improve his hand-eye coordination.

“The mandate has had a huge impact on me and my family,” Cristancho said. “We don’t want to see it go away.”

– Provided by Kaiser Health News.

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Washington, DC, United States (KaiserHealth) – The declared candidates for the Republican presidential nomination have already been campaigning in Iowa, New Hampshire and South Carolina. They’ve held several debates and competed in the Iowa straw poll. But they’re still developing their platform positions and honing their stump speeches.

KHN has assembled this chart to show where five of the candidates currently stand on major health care issues. The candidates are Rep. Michele Bachmann of Minnesota, former Utah Gov. John Huntsman, Rep. Ron Paul and Gov. Rick Perry, both from Texas and former Mass. Gov. Mitt Romney. We will be adding issues – and candidates – in the days ahead.

We have sorted the positions by issue. To compare the beliefs and statements, you can scroll down the page or jump to from these links:

Medicare & Aging

Michele Bachmann

Voted for the Ryan budget plan, but later qualified her support, saying she thought it could hurt senior citizens.

Supports reducing future Medicare benefits for people who are now 55 or younger.

Claimed during the health overhaul debate that the law would create death panels and lead to rationing.

Opposes creation of the 15-member Independent Payment Advisory Board, saying the panel, charged with making binding recommendations to reduce Medicare spending, will cause seniors to lose control over their care.

Voted against allowing the government to bargain with pharmaceutical companies to get lower drug prices for Medicare Part D, arguing it would lead to draconian price controls.

Voted to override Obama’s veto of the Medicare Improvements for Patients and Providers Act of 2008, which temporarily blocked a Medicare pay cut for physicians, prohibited some Medicare Advantage marketing practices, expanded coverage of mental health services and authorized Medicare to cover new preventive services.

“Senior citizens will lose control over what they actually get in Medicare, because a politically appointed 15-member board that’s unelected and unresponsive to the will of the people called IPAB will make the decisions about what care we get and what care we don’t.” — Bachmann to conservative bloggers, June 2011

Jon Huntsman

Backed the Ryan budget plan, which proposed turning Medicare into a “premium support” program to curb spending.

Supported the August 2011 debt-ceiling deal, which leaves entitlement programs untouched in its first phase; the only GOP presidential hopeful to take this position.

“I admire Congressman Paul Ryan’s honest attempt to save Medicare. Those who disagree with his approach incur a moral responsibility to propose reforms that would ensure Medicare’s ability to meet its responsibilities to retirees without imposing an unaffordable tax burden on future generations of Americans.” — Wall Street Journal, May 31, 2011

Ron Paul

Argues that Medicare and other entitlement programs create undesirable dependence on the government, worsening the nation’s financial woes.

Views the Medicare’s Part D prescription drug program as an unwarranted expansion of the government’s role in health care and a “reminder that the GOP sometimes can’t resist the temptation of big government.”

Didn’t take part in Medicare when he practiced medicine; offered low-cost or free care to those who couldn’t afford his services.

Proposes redirecting resources from defense spending to fund Medicare for those already enrolled, while weaning younger people away from such assistance programs in favor of free market approaches.

“Why exactly should Americans be required, by force of taxation, to fund retirement or medical care for senior citizens, especially senior citizens who are comfortable financially? And if taxpayers provide retirement and health care benefits to some older Americans who are less well off, can’t we just call it welfare instead of maintaining the charade about ‘insurance’ and ‘trust funds’?” — Texas Straight Talk weekly address, Nov. 2010

Rick Perry

Argues that, based on the 10th Amendment, states should be able to opt out of Medicare and develop their own means of providing health care.

Led the charge in 2005 against a provision of the Medicare Part D program, which was designed to relieve states of prescription drug costs for low-income elderly people. The policy required states to pay a portion – known as “clawback payments” – of their savings back to the federal government. Perry argued this was unfair to states that had already reduced their Medicaid drug spending. His administration filed a lawsuit in 2006 charging that the policy was unconstitutional.

“I think every program needs to stand the sunshine of righteous scrutiny. Whether it’s Social Security, whether it’s Medicaid, whether it’s Medicare. You’ve got $115 trillion worth of unfunded liability in those three. They’re bankrupt. They’re a Ponzi scheme.” — Newsweek interview, Aug. 12, 2011

Mitt Romney

Said, as president, he would sign the Ryan proposal, but also pledged to put out his own plan for reforming Medicare and Social Security.

Wants to publish federal yearly balance sheet to help people understand the impact of entitlement spending on the budget and economy.

Promises he won’t slice benefits for current seniors or jeopardize their retirement security.

Marketplace

Michele Bachmann

Cites her experience as co-owner with her husband of Bachmann and Associates, a Christian-based mental health care counseling center that employs nearly 50 people.

Sponsored a bill in 2009 that she says would make medical expenses, including insurance premiums, tax deductible for everyone.

Supports the expansion of high-deductible health savings accounts.

Seeks to allow small businesses to band together through trade associations to purchase health insurance for their employees at a lower cost than they can get individually.

Backs tort reform to curb medical malpractice awards.

Jon Huntsman

Pushed as governor for the completion of Utah’s all-payer claims database.

Campaigned for reelection in Utah promising to overhaul the state’s health system and trim the number of uninsured residents.

Signed Utah laws that established a task force to consider comprehensive health system changes, created a tax credit for individuals purchasing a health insurance policy on their own and began setting up an electronic medical records system.

“It is unacceptable that a young father in Clarkston, Utah who works for a small business and wants to buy insurance for his family is denied coverage because of minor ailments. Should eczema or post-partum depression preclude a family from getting affordable health insurance?” State of the State speech, 2008

Ron Paul

Introduced legislation in 2009 to allow patients and physicians to opt out of the electronic medical records system set up by the federal government, to refuse to have those records shared with a third party and to repeal a federal program establishing a “unique health identifier” for each patient.

Supports creating tax credits and deductions for all medical expenses, exempting terminally ill people from paying the employee portion of payroll taxes, providing a payroll deduction to workers who are caring for a spouse, parent or child with a terminal illness.

Opposes caps on awards in medical liability cases.

Endorses a new tax credit for “negative outcomes” insurance bought by patients before medical treatment so they can be compensated for medical mistakes. Says it would reduce “the burden of costly malpractice litigation.”

Supports allowing insurers to sell across state lines, as well as association health plans.

Wants to expand high-deductible health savings accounts.

Rick Perry

Believes policymakers can best improve access to health care by working to improve the economy and increase jobs so that more people are covered under employer-sponsored health plans.

Opposes any federal action that would undermine states’ ability to regulate the health insurance and protect consumers.

Supports medical liability reform/tort reform to reduce frivolous lawsuits and reduce health care costs; cites a Texas measure that became law in 2003 as evidence of effectiveness.

Promoted investments in adult stem cell infusion and helped pass a health care measure that authorized creation of a state adult stem cell bank. He also personally received lab-grown stem cells during a spinal fusion to help with a back injury.

Supports allowing insurance companies to sell across state lines and efforts to help small businesses get better rates on health care plans.

Mitt Romney

Wants to “strengthen” high-deductible health savings accounts by allowing consumers to use them to pay insurance premiums.

Seeks to cap non-economic damage awards in medical malpractices law suits and favors giving states grants to fund other ways to deal with the liability issue, such as health care courts.

Urges restricting federal regulation of health care insurance, although he supports limited rules to bar insurers from denying coverage to those with preexisting conditions when they have had coverage for a specified period of time.

Says insurers should be allowed to sell their products across state lines.

Supports creating a tax deduction for people who obtain health insurance on their own.

Favors allowing individuals and small businesses to join together to buy insurance.

Health Reform Philosophy

Michele Bachmann

Founded the House tea party caucus and is a vociferous critic of the health law.

Co-sponsored legislation in the House to defund the health law.

Introduced in Jan. 2009 the “Health Care Freedom of Choice Act” to allow individuals to deduct all medical expenses.

“The American people spoke soundly and clearly at the ballot box in November and they said to us, ‘Mr. Speaker, in no uncertain terms, repeal this bill.’” — Remarks to the House of Representatives, Jan.’, 2011

Jon Huntsman

Supports repealing the health law, which he says is “top-heavy” and “government-centric.”

Signed in 2008, while governor of Utah, a law to overhaul health care and set up an insurance exchange — one of only two in the United States.

Opposes a federal mandate to require individuals to have health insurance.

Ron Paul

Outspoken opponent of the health law on policy, procedural and constitutional grounds.

Believes the individual mandate is unconstitutional; introduced legislation to end the mandate

Cites his experience as a physician to oppose the implementation of managed care: “We don’t have a right to medical care.”

Introduced legislation to create a market-based system “that reflects consumer choices while rationally pricing services.”

“If medical care is provided by government, this can only be achieved by an authoritarian government unconcerned about the rights of the individual.” — Statement, Sept. 23, 2009

Rick Perry

Called the health law unconstitutional and a “train wreck of a plan” and supports its repeal.

Opposes the creation of a state-based health insurance exchange, as called for in the health law; his veto threat derailed a GOP effort to create a state exchange.

Did not commit to the health law’s high-risk insurance pool program, which was created by the health law, citing lack of program rules and reliable federal funding.

Believes states should develop state-specific health care reforms instead of “Washington’s one-size-fits-all solutions”

Texas is one of the 26 states involved in a multi-state lawsuit challenging the health law.

Signed legislation in July 2011 to clear the path for Texas to join multi-state health care compacts. The compact would, if approved by Congress, enable the state to opt out of federal health care programs and receive federal funds to fulfill those responsibilities.

“The federal government’s attempt to force every American to buy government-approved health insurance is an egregious violation of our Constitutional rights. The 10th Amendment and individual liberties must be protected, and I am committed to fighting the overreach of Obamacare and challenging these unconstitutional mandates, which have gone far beyond both the letter and spirit of the Constitution.” — Statement about district court ruling in Florida vs. HHS, Dec. 13, 2010

Mitt Romney

Known for working with Massachusetts Democrats to enact the precedent-setting 2006 state law requiring most residents to have insurance.

Supported – as part of this law – the creation of an online marketplace called the Health Connector, through which individuals and businesses can purchase insurance.

Argues that the federal law didn’t grow out of the Massachusetts law, saying the state reforms were tailored specifically to meet the needs of the state.

Says, if elected, he’d allow states to opt out of the federal health law and encourage Congress to repeal it.

“Mr. President, if, in fact, you did look at what we did in Massachusetts, why didn’t you give me a call and ask what worked and what didn’t? … I would have told you, Mr. President, that what you’re doing will not work. It’s a huge power grab by the federal government. It’s going to be massively expensive, raising taxes, cutting Medicare.” — GOP candidate debate, June 13, 2011

Medicaid

Michele Bachmann

Strongly opposes the expansion of Medicaid and other low-income health programs such as CHIP; repeatedly has criticized the expansion of Medicaid under the health care law.

Voted against the 2009 stimulus package, which included a temporary enhanced federal matching rate for the Medicaid program, as well as short-term COBRA continuation assistance.

Voted against expanding CHIP in 2009 and 2007.

Denounced last year’s decision by Minnesota Gov. Mark Dayton to expand Medicaid coverage to nearly 100,000 state residents.

Came under scrutiny after media outlets reported that the Christian counseling business she and her husband own received federal and state government funding, including Medicaid payments.

Jon Huntsman

Supports reducing federal funding for Medicaid and turning the program into a block grant to the states.

As governor, implemented a preferred drug list to steer doctors and patients toward lower-cost medications, curb rising costs of Medicaid.

Restored “optional” dental and vision benefits by raising funds through private donations.

Expanded coverage by instituting a year-round open enrollment period for the Children’s Health Insurance Program.

“Let states determine what the percentage of poverty levels are, and let public officials rise or fall on how local citizens feel about those decisions. They’re in a much better position to understand their vulnerable populations than at the federal level.” — Wall Street Journal, June 25, 2011

Ron Paul

Voted against expanding CHIP in 2009 and 2007.

Opposed stimulus package, which included a temporary enhanced federal Medicaid contribution and short-term extension of COBRA coverage.

Rick Perry

Wants states to have more flexibility in administering Medicaid.

Joined with 32 other governors to oppose the health law’s maintenance-of-effort provisions, which prevent states from tightening Medicaid eligibility through 2014.

Opposes the health law’s expansion of Medicaid, arguing it will cost Texas taxpayers more than $27 billion over 10 years starting in 2014. Supports turning Medicaid into a block-grant program, which he says would “improve health care delivery, with innovation, flexibility and local input.”

Pushed a plan late in 2010 to opt out of Medicaid, a proposal that drew resistance from health care and nursing home advocates.

The 2010-2011 state budget signed by Perry included $12 billion in federal stimulus funds.

Outlined a Medicaid vision in 2007 to reduce the number of uninsured Texans by restructuring federal Medicaid funding; unsuccessfully sought a waiver from the HHS to pursue the changes.

Facing budget pressures, the state during Perry’s tenure as governor has relied on cuts to provider payments and controls on pharmacy expenses to rein in the program’s costs.

Texas has the largest percentage of any state’s population that is uninsured, ranks 49th in Medicaid coverage of low-income people and ranks 49th in per capita state spending on Medicaid.

Mitt Romney

Opposes the health law’s expansion of Medicaid coverage to more than 30 million people.

Backs block grants for Medicaid to allow states to use capped federal contributions to run Medicaid as they see fit.

– Provided by Kaiser Health News.

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Washington, DC, United States (KaiserHealth) – As debt limit talks drag on, lawmakers are eying possible changes in Medicare supplemental plans – moves that could increase seniors’ out-of-pocket costs.

Photo by toastbrot81 via FlickrTraditional Medicare, the federal health program for the elderly and disabled, requires beneficiaries to pay hospital deductibles and a portion of the cost of tests and doctor visits. To protect themselves from those out-of-pocket costs, about 17 percent of beneficiaries buy Medigap plans. Another 34 percent get such coverage through a former employer.

But some health policy experts say such “first-dollar protection” drives up demand for Medicare services, costing the government money for what may be unnecessary care. One proposal would bar supplemental insurance from completely eliminating out-of-pocket costs – or charge enrollees a $530 a year extra if they want to keep such protection. That change could save up to $53 billion over 10 years, according to a chart used during the bipartisan talks led by Vice President Joe Biden.

What is Medigap and why do people buy it?

Unlike most job-based health insurance, traditional Medicare does not include “catastrophic” coverage, an annual maximum upper limit on the amount beneficiaries could pay. So enrollees can be liable for thousands of dollars each year, including: $1,132 per-episode deductible for hospital admissions; hundreds of dollars in daily charges for hospital stays of longer than 60 days; a $162-a-year deductible for doctor care, plus 20 percent of charges for office visits or equipment like wheelchairs.

Ten standardized types of supplemental plans offered by private insurers – including AARP’s UnitedHealthcare policies – cover all or most of such deductibles and copayments. Some employers also pay all or part of such costs for their retirees.

What changes are under consideration?

It is not clear exactly what’s on the table in the negotiations between congressional leaders and the White House. But the charts released show that one such proposal under consideration would bar insurers from offering supplemental policies unless the policies came with an annual deductible. People who didn’t want a deductible could pay $530 a year in additional premium to ensure that they won’t be hit with costs before their coverage kicks in.

Is this a new idea?

No. It is a subset of a larger discussion about spending on Medicare and other entitlements. In recent years, the National Commission on Fiscal Responsibility and Reform (The Bowles-Simpson Commission), the Debt Reduction Task Force, the Medicare Payment Advisory Commission and lawmakers, including Sen. Joe Lieberman, a Connecticut independent, and Sen. Tom Coburn, an Oklahoma Republican, have all suggested changing traditional Medicare.

Most of the ideas would create a single annual deductible – generally around $550 – after which beneficiaries would pay about 20 percent of medical costs up to a maximum annual cap, ranging from around $5,000 to more than $7,500.

Would changing supplemental coverage save money?

Some economists and policy experts say that supplemental coverage insulates beneficiaries from medical costs, driving up demand for unnecessary care. A study done for MedPAC in 2009 found that beneficiaries with supplemental insurance used more care and cost the program more money. The increased spending wasn’t for emergency hospitalizations, but for other services such as elective hospital admissions, preventive care, doctor office visits and some types of tests.

Supporters of the insurance say it shields seniors from unpredictable costs and reduces big-ticket expenses by encouraging them to seek help for medical problems before they become severe.

What else do people say about the idea?

Advocacy groups like the Medicare Rights Center oppose restricting Medigap plans, saying it would simply shift more costs from the government to elderly and low-income people who can least afford it. “Some in government feel people in Medicare don’t have enough ‘skin in the game,’” says Ilene Stein, federal policy director for the center. In fact, she says, people on Medicare already pay 15 percent of their incomes for health care, well above the level paid by non-Medicare households. While the proposals would cap maximum annual spending per enrollee to $5,500 or $7,500, “that’s a lot of money for someone making $22,000,” the median household income for those on Medicare, she says.

Still, Joe Antos of the conservative American Enterprise Institute says many of those people already pay large premiums for Medigap coverage – and would likely see those premiums decline if “first-dollar” protections are barred. Antos and Jonathan Gruber, an economist at MIT and consultant to Democrats, both think that if Congress were to change supplemental coverage – or the traditional program itself – that lawmakers would create exemptions for lower-income beneficiaries.

How would the proposal affect a Medigap policy I already own?

Congress would have to decide whether to impose restrictions only on new policies or include existing coverage.

What about people who don’t have a Medigap plan?

Only about 10 percent of seniors don’t have some sort of supplemental coverage. Some people have military/VA benefits, others are in Medicaid, and some have coverage through Medicare Advantage plans, which are insurance policies offered by private insurers as an alternative to traditional Medicare.

What are the chances that these ideas will be adopted by lawmakers?

Because making any change that could be seen as a cut in Medicare benefits carries huge political risk, previous calls for changing the traditional Medicare program or limiting first-dollar coverage through supplemental insurance have not picked up support. But now, when failure to lift the debt ceiling could result in widespread economic problems, a middle-of-the night compromise between warring factions in Congress could put it back on the table.

“Normally, this would be dead on arrival. But this is such a dicey environment that these guys are going to cut some kind of deal at midnight either before or after Aug. 2 in such a hurry that they won’t be worried about the kinds of things people normally worry about when they cut senior benefits,” says Robert Laszewski, an Alexandria-Virginia-based consultant to the health care industry.

Antos is less sure. He says the potential savings of $53 billion over 10 years would be just a tiny slice of any deficit-reduction deal and might not be worth the political hit Congress would take from seniors.

“You can’t sugar coat it,” says Antos. “It would be much easier to do what lawmakers have always done in Medicare, which is lower payment rates (to doctors and hospitals) or restrict services in ways that are subtle and complicated. But to do something that looks like changing benefits, I don’t see it this time.”

– Provided by Kaiser Health News.

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Washington, DC, United States (AHN) – The number of first-time applicants for jobless benefits unexpectedly rose for the week ending April 9 by 27,000 to 412,000.

Analysts had expected the number to remain in the 380,000 range.

Some analysts now say the jump in claims signals uncertainty over recovery in the labor market, while others view it as an anomaly caused by large mass layoffs at the end of the quarter.

Regardless, so far the U.S. recovery from recession has largely been confined to the economic markets with labor not sharing in the nation’s ongoing recovery.

For the week ending April 2 there were 385,000 new claims for unemployment compensation insurance payments, the U.S. Department of Labor said. Initial jobless claims had been trending downward and it was below the 400,000 mark. This marked the first time in five weeks that claims rose above that mark.

Moreover, the four-week moving average, a figure less volatile than the weekly claim numbers, is trending upward again. It increased by 5,500 to 395,750 from the previous week’s revised average of 390,250, DOL officials said.

In addition, the seasonally adjusted rate of jobless workers covered by the unemployment compensation insurance program for the week ending April 2 fell to 2.9 percent from the prior week’s rate of 3 percent.

DOL officials say that there were a total of 8,517,545 people claiming jobless benefits in all programs for the week ending March 26.

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Ottawa, Ontario, Canada (AHN) – The federal government of Canada will announce on Thursday that it will lift the freeze on Employment Insurance premiums. The freeze was part of the economic stimulus package offered by Ottawa to battle the recession.

The lifting of the freeze was originally scheduled Jan. 1, 2010, but the federal government listened to the warning from business leaders, labor representatives and the political opposition that the move would stymie Canada’s recovery.

Finance Minister Jim Flaherty said Ottawa is still reviewing how much the EI rates would go up, but he hinted it would be less than the amount recommended by a rate setting board established by the federal government.

The current rate is $2.42 for employers and $1.73 for employees for every $100 income of the worker. The board recommended a 21 cents hike for employers and 15 cents increase for employees.

On Wednesday, Liberal Party leader Michael Ignatieff withdrew his support for a bill that would improve EI benefits. Ignatieff explained his change of stand to the enhancements being too expensive and no longer needed because it was a product of the recession.

Ignatieff used the EI reforms last year to push for a federal election. His withdraw of support for the bill filed by Bloc Quebecois MP Yves Lessard is a personal stand, not a party stand, Ignatieff clarified.

Lessard’s bill proposed reducing the qualifying period for EI from the present 420 hours minimum to 360 hours, hiking the weekly earnings from 55 percent to 60 percent of past earnings and increasing the length of time benefits could be collected.

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