Saturday, October 15, 2011

PPACA: Long-Term Insurance for the Disabled and Accident Victims Dropped After Nineteen Months!

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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