Obama Plans Health Insurance Appeals

The White House administration announced new federal guidelines for individual and employer health insurance plans which will guarantee consumers the right to an appeal process with an outside neutral party.
The new rules will not take effect until next year because the insurance companies and President Obama’s guidelines is complex. The President is giving state insurance companies time to comply with the new guidelines.
While health insurance companies already have an appeal process in place, these guidelines are more consumer-friendly. If a medical claim is denied, the consumer appeals to the insurance company. If denied again, the consumer has the right to appeal to an outside source at the cost of the insurance company. The ruling of the outside source is binding and if the claim is founded, the insurance company has to pay the claim in full.
Assistant Labor Secretary Phyllis Borzi told reporters the appeals protections do not apply to health plans that were already in place at the time Obama signed the law and are considered "grandfathered." There will be additional guidelines forthcoming for the larger employers hire an insurance company to administer the coverage they pay for directly.
Some opponents of so-called “Obama-care” (the health insurance reform) have said that these guidelines will make health insurance less affordable. If the insurance company has to pay the cost of an outside appeal to a mediator, the costs will be past down to the consumer via increased premiums and the like. One such supporter who does not wish to be identified said, “And you can bet that each denial will come with an appeal just to stick it to the companies any way they can. They aren’t out for health care coverage, they’re mad because they’re poor.”
Supporters disagree, of course. There have been countless cases of denied health insurance that have led to preventable deaths across this nation. It is not the case that these individuals are poor and are out to “stick it” to anyone but that they just want what they feel is owed to them. “I think if I pay premiums for health insurance, I should have coverage, period. It’s what I paid for! If your job hands you a paycheck and then tells you your next job task, and you try and say to them, Sorry, task denied… what do you think they’d do? It shouldn’t work this way and I am glad the President is doing something about it,” says supporter, Tina*.
Either way, most Americans will see the new rules take place by July of 2011.

Montana To Launch Expanded Health Insurance Plan for Children

A plan that combines the Children’s Health Insurance Plan and children’s Medicaid into one entity and in the process broadens free or low-cost health care coverage for young people up to age 19 goes into effect on October 1 in Montana. In November 2008, the initiative that makes this expansion of health insurance for children possible was approved by 70 percent of Montana voters.
Initiation of the new program will make applying for health insurance coverage easier, as it reduces a once 12-page application to nearly half. Parents can also apply for health insurance coverage over the Internet. This is part of the effort to make coverage available to an additional 29,000 children in Montana.
At this point in time, the two separate programs provide health insurance coverage to about 70,000 children. To help ensure the program reaches the additional children who qualify, Montana’s Department of Public Health and Human Services plans to enlist the help of “enrollment partners” that include health care professionals and community-based organizations, and to institute outreach programs in schools and community health clinics.
This new move will bring the total number of Montana’s children covered by health insurance up to about 100,000. Under new income guidelines, a family of four can earn up to $55,125 annually (about 250% of the federal poverty level) and still qualify for the Healthy Montana Kids Plan.
The new health insurance program will cost an estimated $20 to $22 million during the first year, which will bring in additional federal matching monies. A portion of Montana’s insurance premium tax would provide the state’s portion of the cost. Although there are no premiums, some families will have copay requirements.
Items covered under the health insurance plan include office and clinic visits, emergency and hospital services, well-child checkups, mental health services, substance abuse services, dental coverage, vision and hearing exams, and more. Applications for the program are available in all Montana communities in county health departments, health care facilities, WIC offices, Head Start facilities, Indian Health Services, county Offices of Public Assistance, and more.

Pet Owners Upset Over Frustrations with Health Insurance Benefits

Flexcin International, the makers of Flexcin® joint nutrition supplement for people and FlexPet® joint nutrition supplement for pets, reports 12.6 percent more demand for FlexPet this year from people frustrated and disappointed with their pet insurance coverage.
A little more than 150,000 pets are insured and DVM NewsMagazine reported the “stop treatment” threshold for most people is roughly $1,400 in pet health costs. What’s more, a recent analysis by Consumer Reports magazine concluded that pet insurance may not be beneficial to some whose pets never encounter a catastrophic experience.

Pet owners say pet health insurance is not always reliable

More pet owners say they’d be better off providing better preventative care for their pets rather than rely on pet health insurance and wellness programs that often lead to confusing and inconsistent coverage. Demand for FlexPet has increased this year for people looking to nurture their pets’ joints back to good health rather than let insurance cover portions of an expensive joint replacement procedure. Many of these people report their insurance policies are filled with unclear restrictions and confusion surrounding pets with pre-existing conditions.
“With frustrating policy exclusions, fuzzy rules on pre-existing conditions and unclear benefit schedules, pet insurance may no longer be the right decision for my pet and me,” said Christina Fajardo, a pet owner and California resident. “It makes more sense to focus on keeping my pet in good health through regular checkups, proper diet and nutrition. It’s gotten to the point where it’s just as much of a headache as my own confusing heath insurance.”
California ranks as the fifth most popular state in filling FlexPet orders, and demand is expected to rise after Governor Arnold Schwarzenegger recently vetoed legislation AB 2411 calling for better disclosure of pet insurance benefits.
Consumer Reports cited an example in comparing the lifetime cost difference between carrying pet insurance with that of regular veterinary visits and checkups. The analysis showed the pet owner would have paid up to $5,000 more in pet insurance costs compared to the cost of the checkups.

Consumer-Directed Health Insurance Falls Short in Consumer-Directed Health Insurance Falls Short in Arizona

After a lengthy post-election ballot-counting process, the Arizona Secretary of State’s office announced Proposition 101, a groundbreaking health insurance initiative proponents say would have enshrined consumer-directed health care into the state’s constitution by preventing government from forcing citizens to enroll in any particular health insurance plan, failed by the slimmest of margins.
The ballot measure read, “Passage of this proposition would result in an amendment to the Arizona Constitution stating that no law shall be passed that restricts a person’s freedom of choice of private health care systems or private plans, and that no one shall be penalized for opting not to participate in any particular health care system, plan, or coverage.”
The final tally was 1,048,512 votes for Prop 101, and 1,057,199 against—a margin of 8,687 votes, or 0.4 percentage points.
Shot Across the Bow
Experts say Prop 101’s minuscule margin of defeat should send a clear message to legislators considering imposing government-based health care reform on their constituents.
“Politicians need to take note,” said Greg Scandlen, director of Consumers for Health Care Choices at The Heartland Institute. “The people of Arizona have sent a clear warning that they will take only so much high-handed treatment when it comes to health care.
“Whether being forced into a program they have not chosen or being taxed mercilessly for the failed dreams of cynical politicians, voters are reaching the end of their patience,” Scandlen continued.
“It is unfortunate that this basic, fundamental right is under attack and that such an amendment is even necessary,” said Wisconsin state Rep. Leah Vukmir (R-Wauwatosa). “This defense of personal liberty should be presented to the voters in every state, and I applaud Arizonans for leading the way.”
‘Misinformation’ Caused Defeat
Supporters of Prop 101 said a vocal and well-funded campaign against the initiative, which included action by Gov. Janet Napolitano (D), helped seal the measure’s fate.
“When you have the governor and some big health care companies coming into a highly funded ‘no’ campaign, it was something we couldn’t overcome,” Tom Evans, a spokesman for the initiative-sponsoring group Medical Choices for Arizona, told reporters.
“The governor sent out fliers distorting the nature of Prop 101, claiming, among other things, that the measure would raise the cost of health care in the state by $2 billion and would cause employees to lose their employer-sponsored insurance,” explained Dr. Richard Dolinar, a policy advisor to The Heartland Institute and a key figure behind the initiative.
“The claim [that employees would be forced to forfeit their health insurance if Prop 101 passed] was utter nonsense,” said John R. Graham, director of health policy studies at the Pacific Research Institute.
“Prop 101’s plain language made clear that the state could neither forbid any Arizonan from buying private health insurance, nor could it compel him to do so,” Graham continued. “Thus, it would have protected Arizonans from either a government-monopoly system like Canada’s or mandatory private health insurance like in Massachusetts.”
“Although they were neither true nor valid,” said Dolinar, “these arguments proved to be very effective in the ultimate defeat of Prop 101.”
‘All Americans’ Need Health Insurance Choice
An opposition group called Stop 101 raised more than $600,000 for its campaign against the initiative, according to the Tucson Citizen newspaper.
“Opponents of Prop 101 don’t seem to be able to understand the benefits of freedom of choice in health care,” said Graham. “The only ‘reform’ they are willing to consider is so-called ‘single-payer’ health care.
“In Arizona, this took the shape of the Orwellian-named ‘Arizona Health Security Act’ [HB 2668], which would have driven every Arizonan into a government-monopoly system,” Graham continued.
“Imagine a ‘Home Security Act’ that outlawed private houses and compelled everyone into government-owned barracks,” Graham said. “Such a law would be unthinkable! The fact that it is not only thinkable but doable for health care should lead all Arizonans and all Americans to appreciate the need for a constitutional amendment like Prop 101.”

Increased age of sexual consent in Canada may not protect teens at greatest risk: UBC study

The increase in the legal age of sexual consent from 14 to 16 years in 2008 may not be protecting those at greatest risk, according to researchers who have analyzed British Columbia population-based data and recommend additional strategies to safeguard vulnerable children and teens. In the first study of its kind in Canada, researchers from the University of British Columbia and Simon Fraser University tested the government's reasons for changing the law. Their findings are published in the current issue the Canadian Journal of Human Sexuality.
According to the study's lead author, Bonnie Miller, there were two primary reasons given for changing the law: to protect younger teens from being sexually exploited by adults, and to prevent them from making poorer sexual health decisions because of immaturity.
"The law was changed to protect 14 and 15 year olds from adult sexual predators," says Miller, a research assistant in the UBC School of Nursing.
"But it turns out they're not the ones at greatest risk. We found children under 13, already protected by the existing law, were the ones most likely to report first sex with adults age 20 years or older."
Thirty-nine percent of teens who reported sex before age 12 had a first sexual partner who was 20 years or older, but only two to three per cent of 14 and 15 year olds had a first sexual partner who was 20 or older.
"It's important to protect children and teens from sexual exploitation," adds senior author Elizabeth Saewyc, professor of nursing and adolescent medicine at UBC. "But changes in laws should be based on evidence, and our evidence suggests this change isn't going to address the real problem."
The research team analyzed data from the 2008 B.C. Adolescent Health Survey, conducted by Saewyc and the McCreary Centre Society. The province-wide survey included more than 29,000 students in Grades 7 to 12.
When it comes to the other reason given for changing the law, are younger teens less responsible? Not generally. "Most teens are not having sex," says Miller, "but among those who are, we found that 14 and 15 year olds were generally making the same good decisions as 16 and 17 year olds."
The study's additional key findings include:

• 14-15-year-olds were more likely than 16-17 year-olds to report ever being forced to have sex, but this was most often by another youth, not adults
• There were no significant differences between older and younger teens regarding sex under the influence of alcohol or drugs, or teen pregnancy
• A slightly higher percentage of younger teens reported three or more sexual partners in the first year of having sex (18 per cent of younger males compared to nine per cent of older males, nine per cent of younger females compared to four per cent of older females)
• Younger teens were more likely to use condoms, and older teens more likely to use hormonal birth control, but 80-90 per cent of all sexually active teens used some form of effective birth control, and one in three older and younger teens used both condoms and hormonal methods

"The study shows that society needs to do a better job at preventing sexual abuse among children and teens, using strategies that go beyond the legal arena," says Saewyc, who also holds a Canadian Institutes of Health Research (CIHR) Applied Public Health Chair in Youth Health.
"Laws usually only come into play after the abuse has already happened," she says. "If we also talk with young people about sexual violence and about healthy relationships, we can help change attitudes and myths about sexual abuse, encourage children and teens to tell someone if they've experienced abuse, and we may even help change behaviours such as forced sex among teens."
"CIHR recognizes the importance of supporting and advancing research aimed at improving the lives of the most vulnerable," says Nancy Edwards, Scientific Director of CIHR's Institute for Population and Public Health. "We believe that it is essential to work closely with community services, parents, schools and health professionals to tackle sexual abuse issues among children and youth."