Keyword
or Terms: PPACA; Class Act; Long-Terms Health Insurance; Cutting Costs; Quality
of Care; Early or Midstream Change; Kathleen Sebelius; Edward Kennedy; Government
Subsidy; Insurance Premiums; U.S. Department of Health; Inflation; Federal
Reserve Bank Chief; Bureau of Economic Statistics; What; Where; When; Why; and
How.
The uncertainty in the number of injured or disable
persons signing up for insurance and or, the potential huge costs involved in
providing long-term care insurance for the disabled are calling to question the
viability of a portion of the Patients Protection and Affordable Care Act. In
the face of projected rising costs of support for Community Living Assistance
Services and Support (Class) Program, under the Patients Protection and
Affordable Care Act, U.S. Secretary of Health, Katheleen Sebelius, pronounces a dead future for the provision. The resulting impact of reforming health insurance
rather than health care has been blamed as one of the reasons for this
backtracking by the federal government. The blog explores seven cogent questions that are uppermost on the mind of skeptics regarding the choice to drop long-term health insurance provision from the Patients Protection and Affordable Care Act.
An aspect of the health care reform law that was
designed to help disabled citizens during times of illness and accidents while
employed; and one that was billed as a self-sustaining program within the
Patients Protection and Affordable Care Act is being projected as unsustainable;
and thus, must be scrapped. Some health insurance providers have struggled with
pricing premiums at affordable rate for long term health insurance consumers.
The additional cost for covering many disabled consumers out of the fear that
many of these people may not sign up, seems to have scuttled this initiative in
the health care reform law. The uniqueness of this new challenge regarding how
to fix the health care system and or, provide long-term health insurance for
those who really need it but may not all necessarily sign-up in critical mass,
is making me ask the following questions:
1) In light of the reported
growing cost of coverage for long term care, what specific areas of the long
term health insurance program, or the Senator Edward Kennedy shepherd Class
Act, is adding to the costs of the program? As mush as the Department of Health
is ready to junk the long-term health insurance provision in the Patients
Protection and Affordable Care Act, how much has the US Department of Health
done to investigate the underwriting costs if any when the program is
mainstream? How much effort has been devoted to ascertaining the potential
increasing cost of premiums; and or, costs to government if enough potential
beneficiaries fail to sign up. Not every long-term care is prohibitive; and
some aspects of long-term care that are known to carry huge costs are probably
not investigated for possible fraud-threshold or cost containment, since the
introduction of this provision. Further, a fear of factors that may undermine
the success of a program is not necessarily the ultimate outcome determinant
for the program, as other variables may have been exempted at this time, in
assessing the viability of this aspect of the Patients Protection and
Affordable Care Act. The fact that there is a possible lag in the number of
participants in a supposedly self-sustaining health care program, hardly
justifies its complete scrapping.
Projecting that the
revenue base of the Class Act may not allow the program to stand alone within
PPACA is too presumptuous at this time. The groups that are being penalized by
the withdrawal of the long-term care insurance provision want costs to be
manageable to themselves and the government program; none of the patients in
this group subscribes to exorbitant costs and are hardly in collusion with health
care providers. The Logical question is: how do we ensure that those that are
truly in need of long-term care are not being jettisoned for potential rising costs
or premiums alone; and if they are, are the associated reasons for failure to
reach critical mass sufficient enough to convince an objective observer, that
they are completely relevant? U.S. Department of Health must endeavor to
identify those factors that have contributed to the rising premiums and cost of
underwriting long-term care and provide alternative solutions to them rather
that scrapping this provision in the Patients Protection and Affordable Care
Act.
2) What are the major
ailments needing long-term care, how may people have fallen victim of this
health impairments or accidental injury in the past nineteen months; and, how
has insurance companies underwritten and or managed the costs of coverage for
these ailments? Knowing the specific number of patients in the categories of
impaired and disabled persons; and, identifying cost coverage for both groups are
pivotal in assessing and addressing the contributory rising cost of care and
insurance premiums. There are several factors that drive health care, including
administrative costs and inflation; and, if inflation in the past nineteen
months has been tame as provided by the Bureau of Economic Statistics and the
Federal Reserve Bank Chief, where has the rising costs emanating and what
essentially are the parameters that we are looking at, to arrive at the
decision to quit the Class Act provision just after a year and a half. If the
effective costs of inflation are absent from the rising cost of care and
premiums, what then are the factors that have made provision of long-term
insurance coverage prohibitive or one that may lead many not to sign up?.
Occasionally, the United
States Department of Health, like many government agencies, finds it
challenging to adjust and adapt quickly to factors that may be adding to the
costs of running a program. The same can be said of insurance companies’
ability to manage variable factors that keep them from charging increasing
premiums in underwriting long-term health care insurance. Early or Midstream
change in implementation of a law are sometimes unsupported by hard data on the
ground; and all that may be needed in the case of implementing the Class Act, is
a follow-through on factors that may be impeding the effort of providing
long-term care. This new backtrack lacks clarity of purpose and adds to the
ambiguity of understanding why the US Department of Health has been unable to
make a success of this provision; or, are quickly making a three hundred and
sixty degree turn on a provision that has been determined to be essential in
helping patients with long term care needs.
3) How would unsubscribing
to long-term health insurance needs of patients address the health care needs
of many Americans in this cohort? Sometimes, even the role of the health
insurance companies that are supposed to be players in this market, are
suspect, considering that they have often felt that they deserve more from
government programs or bearing the costs
of underwriting long-term health care insurance. If the contemplated challenge
is that of rising cost of subsidizing long-term insurance cost for the disabled
or impaired from accidents, what alternative strategies have been adopted to
address these concerns? When patients in need of long-term care are struggling
to cope with cost of premiums and the federal government agency expected to administer
the program abdicates its responsibility under the health care reform law, who
then do this group turn to? Health Care Delivery for long-term care patients
suffers, when the government drops this essential aspect or provision in the
law. Rumor mongering among initial opponents of the law felicitates and
mistrust of the purpose and essence of the law permeates through the country
with this new development.
4) What was the expected rate
or volume participation in long-term care insurance by the disabled and
accident victims; and how has this contributed to the increasing program cost
that is making the government backtrack? Has there been an increase in
long-term care patients load in hospitals; or participants in the program? It
is important to know if the volume of patients seeking long-term care has
increased since the implementation of the law. Has the volume frustrated the
U.S. Department of Health Staff; or has it added to the issue of revenue
sufficiency of the program? Are there issues raised by long-term health
insurance providers that have advised the U.S. Department of Health to withdraw
from implementing this provision in the Patients Protection and Affordable Care
Act? Increased workload for Departmental Staff may unnerve the resolve to implement
this provision in the law; this in turn may encourage the decreased confidence
in the ability of the U.S. Department of Health to implement this provision. Many
insurance companies may elect to participate in this program or underwrite
long-term health insurance policies; however, when the federal agency expected
to administer the program is circumspect regarding the viability of the
program, how would enough insurance companies participate to help drive down
cost for consumers through competition; or, how can the insurance companies
understand they can make a profit by providing these products?.
5) How much room is there
for retooling the implementation of this provision in the law? It behooves the
U.S. Department of Health to assess the current participation of long-term care
patients and the number of health insurance companies that has joined or
withdrawn from the ranks of provider since the implementation of this provision
or program in the Patients Protection and Affordable Care Act. In many cases,
most insurance underwriters may complain to the U.S. or States’ Department of
Health that they are not making money out of providing long-term insurance care
and thus are about to withdraw their participation in offering a range of
insurance products. Instead of addressing the concerns of these providers, the
U.S. Department of Health may have elected to withdraw implementation or
encouraging future participation. Demonstrated commitment to change is what is
needed in implementing the provisions in the Affordable Care Act; as long as
the Department of Health can maintain accountability in its implementation of
the law, the fear of not reaching a critical mass for a few underwriters should
not be a pivotal reason for withdrawing implementation of the long-term
insurance provision.
6) Where and when is the U.S.
Department of Health constrained in implementing the long-term insurance
provision? How much effort has it made to keep long-term insurance providers
and staff within the agency informed of the new changes and the potential
difficulties that must be addressed to make the implementation of all
provisions of the law a success? How much feedback, favorable and unfavorable,
has the Department of Health received from patients, hospitals and insurance providers
in long-term care business. There are significant implications for not
addressing the scrawny issues regarding the feedback of all stakeholders in
implementing this aspect of the Patients Protection and Affordable Care Act.
Throwing your hands up and saying you give up on this provision, is no option.
This is an area of health care that many treating physician and providers have
complained in the past, was not been receiving needed attention. Where do
patients in this category head for now? Are they expected to recalibrate back
to the pre-PPACA time, when the long-term care patients were dumped or
railroaded from insurance policies because of perceived exorbitant cost of
long-term care? When federal government lowers overall engagement in
implementation of a provision, it is unlikely that the deteriorating
circumstance that necessitated the provision in the law would vamoose.
7) How does the U.S.
Department of Health expect to deal with the resentment from the withdrawal in
the implementation of this provision? It is essential that the federal agency
understand that there were patients depending on the implementation of this
provision of the law. The inability or unwillingness to implement this
provision is more likely an albatross on other aspects of the law. Rather than
a holistic approach in the implementation of the Patient Protection and
Affordable Care Act, the choice of throwing one of the provisions in the law
under the bus undermines optimism and effectiveness of other provisions in the
law when phased in. Withdrawing implementation of all the provisions in the law
may help cut costs or serve some industry group; however, it will not address
the initial reasons for the health care reform law.
Aspects of the law were introduced to ensure that
the health care system begins to deliver value for the patients. Some aspects
of the law were meant to gauge the success of other provisions in the law,
while others were meant to strengthen overall quality of care of the American
Health Care System. For those who have criticized the Class Act as another
entitlement program, it is probably wise to hold your judgment, as this will be
tantamount to misplaced assessment. A few provisions in the Patients Protection
and Affordable Care Act were meant to focus on improvement opportunities in
health care delivery. The new announcement by the U.S. Secretary of Health that
the Class Act is unsustainable and thereby must be jettisoned is neither a
recipe for the success of other aspects of the law nor the overall goal of
improving the American Health Care system.
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