POPULARITY
4 episodes with pocket costs
4 episodes with pocket costs
2 episodes with pocket costs
2 episodes with pocket costs
In this replay/compilation episode, we explore the drastic changes in healthcare costs since the government's increased involvement, particularly focusing on the shift from individual out-of-pocket expenses to public health insurance covering a significant portion of costs. We discuss the economic impacts of these changes, such as rising premiums, claim denials, and the restrictions placed on insurance companies by laws like the Affordable Care Act. The episode emphasizes the need for a free market system to make healthcare more affordable and critiques how government policies have led to inefficiencies and higher costs. (00:00) The Impact of Government on Healthcare Costs (00:35) Historical Healthcare Expenditures: A Closer Look (02:17) Out-of-Pocket Costs and Public Health Insurance (03:21) The Role of Private Health Insurance (04:58) The Free Market Solution to Healthcare (05:19) Affordable Care Act: Challenges and Consequences (06:17) Insurance Mandates and Market Dynamics (07:48) The Economics of Health Insurance (13:25) Conclusion: Addressing the Real Problems in Healthcare
A system revision in Japan in October will increase out-of-pocket expenses for patients who choose original drugs with expired patents over their generic counterparts.
A recent study published in JAMA Health Forum sheds light on the impact of biosimilar competition on patient out-of-pocket (OOP) costs for biologic drugs in the United States. The research,… Source
The cap of $35 takes effect June 1st; Super Micro Computer joins S&P 500 index; United Airlines reviewing safety after spate of incidents; Fitch says pharmacies, healthcare providers could take credit hit following UnitedHealth cyberattack.
Health Policy Expert on Drug Pricing, Antonio Ciaccia discusses the surprising reasons for the costs.See omnystudio.com/listener for privacy information.
Disparities in Care and Barriers to Access for Patients with Advanced Prostate Cancer At the conclusion of these activities, participants will be able to: 1. Recognize current patterns of use for systemic therapies in patients with advanced prostate cancer. 2. Identify disparities in access to care with respect to advanced prostate cancer treatment (ie. race, geography, socioeconomics). 3. Understand opportunities to improve quality and compliance with ADT treatment across different treatment populations. 4. Appreciate financial challenges that may be associated with current therapy options for advanced prostate cancer. 5. Apply treatment approaches that improve patient adherence to ADT including use of oral and parenteral therapies. ACKNOWLEDGEMENTS: This series is supported by independent educational grants from: Myovant Sciences LTD Pfizer, Inc. REFERENCES: Benjamin, D.J., Shrestha, A., Fellman, D. et al. Hormonal treatment for newly diagnosed metastatic prostate cancer: a population-based study from the California cancer registry. Prostate Cancer Prostatic Dis (2023). https://doi.org/10.1038/s41391-023-00732-9 Cortese BD, Dusetzina SB, Al Hussein Al Awamlh B, Penson DF, Chang SS, Barocas DA, Luckenbaugh AN, Scarpato KR, Moses KA, Talwar R. Estimating the Impact of the Inflation Reduction Act on the Out-of-Pocket Costs for Medicare Beneficiaries With Advanced Prostate Cancer. Urol Pract. 2023 Sep;10(5):476-483. doi: 10.1097/UPJ.0000000000000425. Epub 2023 Jul 3. PMID: 37409930.
Health Policy Expert and Ohio State Graduate, Antonio Ciaccia goes in depth on how we are being dinged with high prices!
Antonio Ciaccia, Lead Health Policy Expert and President of 3 Axis Advisors, talks about a news study by 3 Axis Advisors to determine just how prices are being set for prescription drugs.
Antonio Ciaccia, Lead Health Policy Expert and President of 3 Axis Advisors, talks about a news study by 3 Axis Advisors to determine just how prices are being set for prescription drugs.
Treatment with buprenorphine is approved and effective for adolescents with opioid use disorder (OUD) but is underused. JAMA Pediatrics Editor in Chief Dimitri Christakis, MD, and JAMA Pediatrics Associate Editor Alison A. Galbraith, MD, discuss diagnosis and treatment of OUD with Scott Hadland, MD, Chief of Adolescent Medicine at Massachusetts General Hospital, Boston, and an expert in adolescent OUD. Related Content: Out-of-Pocket Costs and Payer Types for Buprenorphine Among US Youth Aged 12 to 19 Years Conflict of Interest disclosures: Dr Hadland has received honoraria from the American Academy of Pediatrics for speaking on the topic of adolescent opioid use disorder treatment.
The high cost of cancer treatment in the U.S. is literally killing people. “Over a quarter of cancer patients delay medical care, go without care, or make changes in their cancer treatment because of cost,” Ezekiel J. Emanuel, an oncologist and co-director of the Health Care Transformation Institute at the University of Pennsylvania, wrote in a recent First Opinion essay. But Emanuel says there's a solution: Cancer patients shouldn't have to pay any out-of-pocket costs for their treatment, especially in the first (and typically most expensive) year after diagnosis.
Commentary by Dr. Valentin Fuster
Too many Americans are struggling to access and afford their healthcare. But, adults largely agree on what policymakers at the state level should be doing to deliver relief to patients at the pharmacy counter. A new nationwide poll on behalf of PhRMA finds that 86 percent agree that lowering out-of-pocket costs should be a top priority. A majority in all 50 states (plus D.C.) support solutions that would help patients pay less for their medicines—and provide better oversight of middlemen. Among the most-popular solutions is ensuring that patients don't pay more for their medicine than insurance companies or their middlemen, such as pharmacy-benefit managers (PBMs): 80 percent of adults agree that lawmakers should require them to pass the rebates and discounts that they receive directly to patients. Other popular solutions include: Ensure that insurers and middlemen are held accountable for their role in creating barriers between patients and the medicines that they need. (83 percent) Require all insurance plans to cover certain medications used to treat chronic conditions from day one of the plan year. (81 percent) Require insurers to count patient assistance—such as cost-sharing assistance—toward the patient's deductibles. (76 percent) Require insurers to cover medicines from day one by offering at least some plan options that exclude medicines from deductibles and only charge set copay amounts. (76 percent) Cap the amount of cost-sharing—such as deductibles and coinsurance—that patients pay out-of-pocket for their medicines. (75 percent) As lawmakers look for ways to address affordability and access to healthcare, many are questioning abuses of the system by PBMs and insurers. Luckily, there are several solutions that state legislators can implement today that would bring real improvements and more accountability. To learn more, visit PhRMA.org/States. This poll was conducted by Morning Consult, on behalf of PhRMA, in late March, among a national sample of 20,017 adults.
In this FAQ episode, we're answering the questions: What are my out of pocket costs? How long does it take to lease a property? Transcript--To learn more about our full-service turnkey operations, check us out online at www.spartaninvest.com.Connect with Spartan!Facebook: @spartaninvestInstagram: @spartaninvestTwitter: @spartaninvestConnect with Lindsay!Facebook: @spartanlindsaydavisInstagram: @spartanlindsaydavis
This week we discuss Docker's Business Model, the Stack Overflow's Sentiment Survey and ChatGPT use cases. Plus, some predictions about VR/AR headsets. Watch the YouTube Live Recording of Episode 406 (https://www.youtube.com/watch?v=hxvIBIzlmbM) Runner-up Titles Free isn't good enough I'm not that disconnected It's a presentation with yourself We still hate this Open Source Continuity Founder Magic Syntactic Sugar How cool do you feel, Tim Cook? Rundown Docker is deleting Open Source organisations - what you need to know (https://blog.alexellis.io/docker-is-deleting-open-source-images/) Docker's bad week (https://www.infoworld.com/article/3691292/dockers-bad-week.html) After the buzz fades: What our data tells us about emerging technology sentiment (https://stackoverflow.blog/2023/03/09/after-the-buzz-fades-what-our-data-tells-us-about-emerging-technology-sentiment/) Best printer 2023: just buy this Brother laser printer everyone has, it's fine (https://www.theverge.com/23642073/best-printer-2023-brother-laser-wi-fi-its-fine) The ‘Enshittification' of TikTok (https://www.wired.com/story/tiktok-platforms-cory-doctorow/) Google has discontinued the Glass Enterprise Edition (https://9to5google.com/2023/03/15/google-glass-enterprise-edition-discontinued/) Meta's metaverse is on the back burner (https://www.axios.com/newsletters/axios-login-c7503b12-b371-4a85-86f0-dacb9b3426fc.html?chunk=0&utm_term=emshare#story0) Who Is Still Inside the Metaverse? (https://nymag.com/intelligencer/article/mark-zuckerberg-metaverse-meta-horizon-worlds.html) Meta announces big price cuts for its VR headsets (https://www.cnbc.com/2023/03/03/meta-quest-pro-vr-headset-gets-price-cut.html) Mark Gurman details Apple's Reality Pro headset (https://www.gsmarena.com/mark_gurman_gives_huge_breakdown_of_apples_reality_pro_headset-news-57314.php) Relevant to your Interests 4K Blu-Rays Vs. 4K Streaming: Which Is the Best Way to Enjoy Movies? 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Strategy (https://twitter.com/ENERGY/status/1631412407565180928?s=20) Richard Seroter's take on Web Assembly (https://twitter.com/rseroter/status/1631723362371371008?s=20) VMware's SaaS Sales Surge As Broadcom Deal Nears (https://www.crn.com/news/channel-news/vmware-s-saas-sales-surge-as-broadcom-deal-nears) Technology Chiefs Seek Help Wrangling Cloud Costs (The Wall Street Journal) (https://artifact.news/s/ZAPppeImSUI=) Top Apple Supplier Foxconn Plans Major India Expansion (https://www.wsj.com/articles/top-apple-supplier-plans-major-india-expansion-f2908b88) Zoom boss Greg Tomb fired ‘without cause' (https://www.bbc.com/news/technology-64835239) A cloud migration in wartime (https://www.mckinsey.com/capabilities/mckinsey-digital/our-insights/a-cloud-migration-in-wartime) Apple's VP of Cloud Engineering Michael Abbott Reportedly Leaving Company in April (https://www.pymnts.com/apple/2023/apples-vp-of-cloud-engineering-michael-abbott-reportedly-leaving-company-in-april/) ARM vs Intel on Amazon's cloud: A URL Parsing Benchmark (https://lemire.me/blog/2023/03/01/arm-vs-intel-on-amazons-cloud/?ck_subscriber_id=512840665) Microsoft brings an AI-powered Copilot to its business app suite (https://techcrunch.com/2023/03/06/microsoft-dynamics-copilot/?guccounter=1&guce_referrer=aHR0cHM6Ly9uZXdzLmdvb2dsZS5jb20v&guce_referrer_sig=AQAAAGcA6HN4Zti_4dKCpuMURoiAkkQ_uR0GBWFOG215KnmRsvryBDclj9SjWv-95R0yA0wFRXevcP-HUdwk-E3ZyR3d23rc5VGVCNXFGK5L3mAPvoEOJxRs6WZFKQvDUBIyw5V3NpdWGkkQ-fXDh4Rijfdp2l_ekJTxepVJjoYJSyKz) NOSSHJJ talking about 1Password (https://www.youtube.com/watch?v=vfmKwjiVf-U) Alphabet headcount on Google Cloud (https://twitter.com/jordannovet/status/1632842179281387522) How a single engineer brought down Twitter on Monday (https://www.platformer.news/p/how-a-single-engineer-brought-down?utm_source=substack&utm_medium=email) Kubernetes as a platform vs. Kubernetes as an API | Amazon Web Services (https://aws.amazon.com/blogs/containers/kubernetes-as-a-platform-vs-kubernetes-as-an-api-2/) Atlassian to Eliminate 500 Jobs in Latest Software Cutbacks (https://www.bloomberg.com/news/articles/2023-03-06/atlassian-will-eliminate-500-jobs-in-latest-software-cutbacks?leadSource=uverify%20wall&utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axioslogin&stream=top#xj4y7vzkg) Even Slack has a ChatGPT app now (https://www.engadget.com/even-slack-has-a-chatgpt-app-now-154334452.html) The Pursuit of Shareholder Value: Cisco's Transformation from Innovation to Financialization (https://www.ineteconomics.org/research/research-papers/the-pursuit-of-shareholder-value-ciscos-transformation-from-innovation-to-financialization) Google I/O 2023 takes place on May 10th in front of a 'limited' in-person audience (https://www.engadget.com/google-io-2023-takes-place-on-may-10th-in-front-of-a-limited-in-person-audience-232154501.html) Datadog's software is down — and so is its stock (https://www.marketwatch.com/story/datadogs-software-is-down-and-so-is-its-stock-3d0dc2e6) Southwest lands on AWS as preferred cloud for modernization push (https://www.ciodive.com/news/Southwest-airlines-AWS-cloud-modernization/644510/) Microsoft says Bing has crossed 100 million daily active users | Engadget (https://www.engadget.com/microsoft-bing-crossed-100-million-daily-active-users-080138371.html) SCOOP: Stripe Is Raising $6 Billion to Resolve Taxes & Expiring Employee Shares, Delaying Public Listing (https://www.newcomer.co/p/scoop-stripe-is-raising-6-billion) After Stadia, Google's new gaming roadmap (https://www.axios.com/newsletters/axios-login-231e8237-d33a-4d1a-b810-5e2e729eff66.html?chunk=2&utm_term=emshare#story2) GM offers buyouts to 'majority' of U.S. salaried workers (https://www.cnbc.com/2023/03/09/gm-buyouts-us-salaried-workers.html) Meta is building a decentralized, text-based social network (https://www.platformer.news/p/meta-is-building-a-decentralized?utm_source=substack&utm_medium=email) VMware turns to containerization to improve virtual apps (https://www.theregister.com/2023/03/09/vmware_apps_on_demand/) Exclusive: Meta mulls a Twitter competitor codenamed ‘P92' that will be interoperable with Mastodon (https://www.moneycontrol.com/news/business/startup/meta-mulls-a-twitter-competitor-codenamed-p92-that-will-be-interoperable-with-mastodon-10223961.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axioslogin&stream=top) Oracle shares sink nearly 5% after third-quarter revenue miss (https://www.cnbc.com/2023/03/09/oracle-shares-sink-nearly-5percent-after-third-quarter-revenue-miss.html) How Ahrefs Saved US$400M in 3 Years by NOT Going to the Cloud (https://tech.ahrefs.com/how-ahrefs-saved-us-400m-in-3-years-by-not-going-to-the-cloud-8939dd930af8) U.S. government steps in and says people with funds deposited at SVB will be able to access their money (https://www.cnbc.com/2023/03/12/regulators-unveil-plan-to-stem-damage-from-svb-collapse.html) Joint Statement by the Department of the Treasury, Federal Reserve, and FDIC (https://home.treasury.gov/news/press-releases/jy1337) GitLab loses one-third of its value after software company issues weak revenue forecast (https://www.cnbc.com/2023/03/13/gitlab-gtlb-earnings-q4-2023.html) Hashi Stack To Break $1 Billion, With Profits, In Two Years (https://www.nextplatform.com/2023/03/10/hashi-stack-to-break-1-billion-with-profits-in-two-years/) Gowalla returns to see if location-based networking is ready for its mainstream moment (https://techcrunch.com/2023/03/10/gowalla-location-based-social-app/) Amazon's New Home Internet Service Announces New Details | Cord Cutters News (https://cordcuttersnews.com/amazons-new-home-internet-service-announces-new-details/) Grammarly's New AI Tool Can Do More Than Check Your Spelling (https://www.cnet.com/tech/services-and-software/grammarlys-new-ai-tool-can-do-more-than-check-your-spelling/) Google Cloud gives developers access to its foundation models (https://techcrunch.com/2023/03/14/google-cloud-gives-developers-access-to-its-foundation-models/) The inside story on Mountpoint for Amazon S3, a high-performance open source file client (https://aws.amazon.com/blogs/storage/the-inside-story-on-mountpoint-for-amazon-s3-a-high-performance-open-source-file-client/) Meta to Lay Off Another 10,000 Workers (https://www.nytimes.com/2023/03/14/technology/meta-facebook-layoffs.html) Zed raises $10M for a code editor built for collaboration (https://techcrunch.com/2023/03/15/zed-code-editor-raises-10m/) Apple is reportedly experimenting with language-generating AI (https://techcrunch.com/2023/03/16/apple-is-reportedly-experimenting-with-language-generating-ai/) Twitch CEO Emmett Shear is stepping down (https://techcrunch.com/2023/03/16/twitch-ceo-emmett-shear-is-stepping-down/) The Four Domains of Wasm (https://www.fermyon.com/blog/four-domains-wasm) Navigating SVB's new era (https://www.axios.com/newsletters/axios-pro-rata-3bd96e9e-2dbf-4d32-8008-30800f298ac7.html?chunk=0&utm_term=emshare#story0) Hewlett Packard Enterprise to acquire OpsRamp, advancing hybrid cloud leadership and expanding HPE GreenLake into IT Operations Management (https://www.hpe.com/us/en/newsroom/press-release/2023/03/hewlett-packard-enterprise-to-acquire-opsramp-advancing-hybrid-cloud-leadership-and-expanding-hpe-greenlake-into-it-operations-management.html) Proximus and Google Cloud to Deliver Sovereign Cloud Services in Belgium and Luxembourg (https://www.proximus.com/news/2023/20230315-disconnected-sovereign-cloud-platform.html) Netflix plans 40 more game releases in 2023 (https://www.axios.com/2023/03/20/netflix-40-video-games) Dragonfly - Dragonfly Is Production Ready (and we raised $21m) (https://dragonflydb.io/blog/dragonfly-production-ready) HPE picks up OpsRamp for Greenlake multi-cloud AIOps (https://www.theregister.com/2023/03/20/hpe_opsramp_acquisition/) Nutanix To Miss SEC Deadline Amid Internal Software Probe (https://www.crn.com/news/cloud/nutanix-to-miss-sec-deadline-amid-internal-software-probe) Nutanix's latest bumper financials overshadowed by 3rd party evaluation software probe – Blocks and Files (https://blocksandfiles.com/2023/03/07/terrific-nutanix-results-overshadowed-by-expense-investigation/) AWS Cost Leaderboard (https://leaderboard.vantage.sh/) GitHub releases blueprint for budding open source program offices (https://techcrunch.com/2023/03/15/github-releases-blueprint-for-budding-open-source-program-offices/) Introducing GPT-4 in Azure OpenAI Service (https://azure.microsoft.com/en-us/blog/introducing-gpt4-in-azure-openai-service/) Cloud Repatriation Trends: Where Are We Now? (https://blog.container-solutions.com/cloud-repatriation-trends-where-are-we-now) The cloud backlash has begun: Why big data is pulling compute back on premises (https://techcrunch.com/2023/03/20/the-cloud-backlash-has-begun-why-big-data-is-pulling-compute-back-on-premises/) Nonsense Goldman Sachs arm among bidders with appetite for $10bn Subway (https://news.sky.com/story/goldman-sachs-arm-among-bidders-with-appetite-for-10bn-subway-12825817) This smart toaster lets you cook two slices of bread at different temperatures at the same time (Yanko Design) (https://artifact.news/s/Ug-RYHqMfFE=) A Matt Levine Effect? (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4386256) Tiny data centre used to heat public swimming pool (https://www.bbc.co.uk/news/technology-64939558) Man Sues Buffalo Wild Wings Over ‘Boneless' Wings (https://www.nytimes.com/2023/03/14/business/buffalo-wild-wings-boneless-wings-lawsuit.html) Metallica Acquires Furnace, One of America's Largest Vinyl-Manufacturing Companies (https://variety.com/2023/music/news/metallica-acquires-furnace-vinyl-pressing-plants-1235553683/) Got a question for Twitter's press team? The answer will be a poop emoji (https://www.npr.org/2023/03/20/1164654551/twitter-poop-emoji-elon-musk?_hsmi=251042455) Sponsors The MacGeekGab.com Podcast (https://www.macgeekgab.com) provides tips, Cool Stuff Found, and answers to your questions about anything and everything Apple. Subscribe now! 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Breanna has been in the points game for a few years, and has even booked bucket list points trips to the Seychelles on points, and has still been able to really level up since enrolling in The Points Accelerator program. In this episode, Breanna and I discuss different expenses that can earn you more points, how to prioritize earning points vs. other values like minimizing overall cost, and a recent trip that she has booked for London using points and free night certificates where she saved more than $7000! If you are interested in leveling up your points game and earning many more points without needing to open 20 different cards, we are opening up for another cohort soon! You can join the waitlist by checking out www.geobreezetravel.com/waitlist to be one of the first ones to hear about when we open for new students! The Points Accelerator Waitlist: https://www.geobreezetravel.com/waitlist Swagbucks: https://www.geobreezetravel.com/swagbucks You can find Julia at: Start here: https://www.geobreezetravel.com/starthere Website: https://www.geobreezetravel.com Instagram: https://www.instagram.com/geobreezetravel Credit card links: https://www.geobreezetravel.com/cards Masterclasses: https://www.geobreezetravel.com/hangouts Patreon to access recordings of masterclasses: https://www.patreon.com/geobreezetravel Award travel coaching call: https://www.geobreezetravel.com/calendly Sign up for the newsletter and get exclusive access to sign up for free coaching calls: https://www.geobreezetravel.com/free-coaching Geobreeze Travel is part of an affiliate sales network and receives compensation for sending traffic to partner sites, such as milevalue .com. This compensation may impact how and where links appear on this site. This site does not include all financial companies or all available financial offers. Terms apply to American Express benefits and offers. Enrollment may be required for select American Express benefits and offers. Visit americanexpress .com to learn more.
Dean Clancy is a senior policy fellow at Americans for Prosperity and a Paragon Health Institute public advisor. How Obamacare premiums and out of pocket costs are rising.
This is perhaps the final part in our series on the Turnaway Studies. The last part focuses on what happens when women are made to undergo an unneccesary ultrasound as a condition to get an abortion. And also, another perhaps under-covered way that abortion care is even more unaffordable for many people. These are all things that are perpetrated on uterus havers by Republicans. So... I guess what I'm saying is VOTE THEM OUT Links: Kimport et al (2014) Beyond Political Claims: Women's Interest In and Emotional Response to Viewing Their Ultrasound Image in Abortion Care, Roberts et al (2014) Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States , Guttmacher Institute: State Policies Regulating Abortion Coverage
One person doesn't know if their properties are worth the out-of-pocket costs.
Reducing out-of-pocket costs for patients is a critical skill for all clinicians. In this episode, we explore how residents and fellows can be leaders through promoting value-based care. It can be useful to think of unnecessary costs to patients as financial toxicity, and to understand the impacts of financial toxicity on the health of patients. We also discuss how to have cost conversations with patients and how to advocate for healthcare value. Faculty: Ari Hoffman, MD Resident: Michael Trainer, MD
Commentary by Dr. Valentin Fuster
In the wake of the leaded Supreme Court decision to essentially overturn Roe v. Wade, we decided to do an episode on the science of abortion attitudes. Manny and Dylan discuss Americans' attitudes towards abortion with Dr. Kristen Jozkowski, who is the William L. Yarber Endowed Professor in Sexual Health at Indiana University Bloomington. She has written extensively on the topic of public opinions on abortion. As with all of the topics we cover, abortion attitudes are complicated! PBS article: Majority of Americans don't want Roe overturned 538 article using polling: Where Americans Stand On Abortion, In 5 Charts Dr. Jozkowski article: Abortion Complexity Scores from 1972 to 2018: A Cross-Sectional Time-Series Analysis Using Data from the General Social Survey Dr. Jozkowski research: “Roe v. Wade” versus “Legalized Abortion”: Wording effect influences on survey responses 92% of abortions occur in the first trimester Information deficit model of science communication review Dr. Jozkowski research: Examining the Relationship Between Roe v. Wade Knowledge and Sentiment Across Political Party and Abortion Identity Out-of-Pocket Costs and Insurance Coverage for Abortion in the United States Dr .Jozkowski research: If it's legal, it's easy: (Mis)perceptions of abortion access across the US Dr. Jozkowski research: DO RACE AND PREGNANCY SITUATION AFFECT EMPATHY FOR WOMEN WHO SEEK ABORTIONS IN ARKANSAS? A RANDOMIZED- CONTROLLED VIDEO INTERVENTION Benevolent sexism predicts attitudes towards abortion Find out more about Dr. Jozkowski's research at @IU_DAMSS_team & @KMJozkowski
Being able to afford out-of-pocket prescription drug medications is a problem for millions of Americans, especially older adults. Every year, Medicare beneficiaries pay on average over 3,200 in out-of-pocket expenses for prescription drugs. For an older adult on a fixed income, this is no small chunk of change. Alliance for Aging Research Vice President of Public Policy Michael Ward is joined by Amy Niles, Executive Vice President of the PAN Foundation to talk about why out-of-pocket costs are so high, the real-world impacts of growing out-of-pocket costs for older adults, and what we can do about it.
This episode features a conversation between Emmy Ganos, PhD, Senior Program Officer at the Robert Wood Johnson Foundation and Stacie Dusetzina, PhD, Associate Professor of Health Policy and Ingram Associate Professor of Cancer Research at Vanderbilt University Medical Center. This session is the last of four talks focused on health care sector efforts to Adjust clinical care based on information about patients' social circumstances. In this conversation, Emmy and Stacie dive into the implications of real-time pharmacy benefit tools and explore what we know about patient and provider preferences when it comes to conversations about medication costs.Recommended references: Everson J, Frisse ME, Dusetzina SB. Real-Time Benefit Tools for Drug Prices. JAMA. 2019. Doshi JA, Li P, Huo H et al. Association of Patient Out-of-Pocket Costs with Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents. J Clin Oncol. 2018. Sloan CE, Ubel PA. The 7 Habits of Highly Effective Cost-of-Care Conversations. Annals Intern Med supplement issue on cost-of-care conversations. 2019. America's Essential Hospitals. Cost of Care Conversations Resources. Web collection.
Dr. Daniel Hartung discusses out-of-pocket costs for MS drugs.
In the first segment, Dr. Stacey Clardy talks with Dr. Daniel Hartung about whether closing the Part D coverage gap between 2010-2019 lowered patients' out-of-pocket costs for multiple sclerosis drugs. In the second part of the podcast, Dr. Teshamae Monteith discusses sex, exercise, and other benign causes of thunderclap headache with Dr. Jonathan Smith in the final part of our four-part series on thunderclap headache.
SMA News Today's multimedia associate, Price Wooldridge, discusses a partnership which aims to lower out-of-pocket costs for rare disease medications. Also, Forums Director Kevin Schaefer reads a column by Sherry Toh about her love for video games. Are you interested in learning more about spinal muscular atrophy? If so, please visit https://smanewstoday.com/
Semaglutide works for weight loss but at what co$t? BOARD CHANGER- New gonorrhea guidelines Diabetes drugs are expensive for our patients and we can't forget that. Children find it hard to tell what facial expression you are giving when you have a mask on! https://www.nejm.org/doi/10.1056/NEJMoa2032183 industry-conducted trial published in the New England Journal of Medicine. Researchers randomized nearly 2000 participants without diabetes who were either overweight with at least one weight-related comorbidity or obese to receive All2.4 mg subcutaneous semaglutide or placebo weekly for 68 weeks. mean bmi 38. weighing at 105 lbs. Mean weight loss was significantly greater with semaglutide than placebo (15% vs. 2%), as was the percentage of patients losing >5% of body weight (86% vs. 32%). difference is 31lbs-- over 68weeks or 16 months.. the drug cost 734$ per month. that is 11,744 for treatment or 379 per pound. not worth it to me twitter and say shouldnt you have the conversation?!? BOARD CHANGER The CDC now recommends treating uncomplicated gonorrhea with a single 500-mg intramuscular dose of ceftriaxone, according to updated guidelines in MMWR. The recommendation applies to urogenital, anorectal, and pharyngeal infections. Previously, the CDC recommended ceftriaxone plus oral azithromycin. The authors note that azithromycin resistance is "an increasing concern." Nationwide, the percentage of N. gonorrhoeae isolates with reduced susceptibility to azithromycin increased from 0.6% in 2013 to 4.6% in 2018. Among the recommendations: People weighing ≥150 kg should be given a single 1-g dose of ceftriaxone. In patients for whom a chlamydial infection has not been ruled out, doxycycline 100 mg orally twice a day for 7 days is also recommended. For patients with cephalosporin allergy, an intramuscular dose of gentamicin (240 mg) plus an oral dose of azithromycin (2 g) may be considered. In cases where intramuscular ceftriaxone can't be given, an oral dose of cefixime (800 mg) is an option, but the authors note it may not be as effective. For pharyngeal gonorrhea, there are no reliable alternative therapies and test-of-cure is recommended. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 | MMWR BOARD ANSWER CHANGER https://news.wisc.edu/can-blocking-a-frown-keep-bad-feelings-at-bay/ remember that article back in 2010 which basically showed those people to get botox had decrease ability to defer emotions or facial expressions of others?? It was out of the university of wisconin and not they are back at it with this article---- https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0243708 Children’s emotion inferences from masked faces: Implications for social interactions during COVID-19 Plos one This study took 81 7-13yr old child to see how children perceived others’ emotions as partial information about the face was presented pictures of stereotypical facial configurations associated with sadness, anger, and fear posed by male and female models. Pictures were presented in unaltered format (i.e., with no covering) or digitally altered to be (a) covered with a surgical face mask that obscured the mouth and nose, or (b) covered with sunglasses that obscured the eyes and eyebrows The primary question addressed by this study is whether masks meaningfully degraded children’s ability to infer others’ emotions “Accuracy between the faces that wore masks and shades did not differ” And that was the others conclsuions “These data suggest that while there may be some challenges for children incurred by others wearing masks, in combination with other contextual cues, masks are unlikely to dramatically impair children’s social interactions in their everyday lives” But that doesn’t tell the whole story Because when you look at the results you see that both sunglasses and mask did present a challenge for kids compared to no mask or no sunglasses. About a 10% absolute difference or a 33% realtive difference and althought you cant really use NNT in this type of trial if you were that would be a NNH of 10. For every 10 kids, 1 kid has a dramatic impairment in their ability to infer others emotions with the use of mask or sunglasses This is not me being antimask. This is not me saying that mask are the devil. This is me saying there are real effects to what we are doing and we have to be prepared for them and one of them might be children that are not able to infer emotions as well. Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 new guidelines regarding treatment of gonorrhea- Prior recommendations had included treating a patient for both gonorrhea and chlamydia when there was a positive gonorrhea test regardless of chlamydia results. These updated guidelines recommend not treating a patient for chlamydia if the patient is diagnosed with gonorrhea if testing shows no chlamydia infection. Treatment for both is still recommended if chlamydia status is unknown. Dosing for gonorrhea treatment was also increased from ceftriaxone 250mg IM to 500mg IM, and treatment for coinfection with chlamydia was changed from azithromycin to doxycycline with a longer course of 7 days. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2020. 2922?guestAccessKey=3ed2a6bb-bc67-4b5e-955c- 08cc5b7bedf6&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert- jamainternalmedicine&utm_content=etoc&utm_term=120720 ben franklin is linked to the famous saying “a penny saved is a penny earned” well I wonder what he would say about our next and last paper titled- Out-of-Pocket Costs for Novel Guideline-Directed Diabetes Therapies Under Medicare Part D Which did exactly as the article suggests and looked at the cost of novel diabetic agents under Medicare part D which covers almost 45,000,000 people. They reviewed 6 drug classes and projected annual out-of-pocket costs Across near 3000 Part D plans commonly covered GLP-1RAs, SGLT2is, and DPP-4is had monthly list prices between $434 to $935 compared with $3 to $11 for metformin, sulfonylureas, and TZDs. What does that mean for your patient, how does that translate into real world information?? Well, annual costs for common novel agents were $5202 to $11 225 with only $31 to $136 for traditional drugs And the Projected annual out-of-pocket cost for novel drug regimen were $1231 to $1981, compared with $250 to $355 for traditional regimens. Considering at best these new agents have a NNT of 20 the variability to prevent one nonfatal event that approaches 100K needs to be seriously looked at.
Do you want to know how much money you have to come out of pocket to buy a home? Or put another way, do you want to know how much money you have to save to buy a house?Those are the topics we talk about in this episode. Get out your calculator!
Dr. Chloe E. Hill discusses the Neurology Journal article, "Increasing Out-of-Pocket Costs for Neurologic Care for Privately-Insured Patients". Show references: https://n.neurology.org/content/early/2020/12/23/WNL.0000000000011278
Dr. Stacey Clardy talks with Dr. Chloe Hill about increasing out-of-pocket costs for privately-insured patients to obtain neurologic diagnostic services.
The university plans to test all of its campus residence hall students by the beginning of September. It will continue to conduct random testing and identify individuals or groups on campus strategically to test those at a higher risk of disease spread.
Conversations about MS almost always get around to the high cost of MS disease-modifying therapies. Joining me on the podcast is the CEO of Genentech, Alexander Hardy. Genentech is a biotech company that many of you know as the manufacturer of Ocrevus, the first approved disease-modifying therapy that treats both relapsing-remitting MS and primary progressive MS. During our wide-ranging conversation, Alexander and I get into the cost of MS prescription medications, the real costs of bringing a new drug to market, racial disparities in clinical trials, inequities in our healthcare system, and more. It's a conversation that you won't want to miss. We'll also tell you where you can get a FREE copy of Dr. Brandon Beaber's book, Resilience in the Face of Multiple Sclerosis, and where to sign up for the next series of Virtual Jumpstart programs from CAN-DO MS. We'll even share the details about this Sunday's Longest Day of Golf, a creative (and very successful!) DIY fundraising event for the National MS Society. We're also talking about a newly published study that shows that most relapsing-remitting MS disability accumulation is progressive and not tied to relapses. And we'll tell you about another study that shows that most people living with MS want to discuss the cost of their treatment with their neurologist, but very few do. We'll even share our thoughts about how we can begin to fix this. We have a lot to talk about! Are you ready for RealTalk MS??! It's Our 150th Episode! :22 Get in Touch with RealTalk MS 1:36 Get Your Free Copy of Resilience in the Face of Multiple Sclerosis 3:34 CAN-DO MS Virtual Jumpstart Programs 4:43 The Longest Day of Golf Fundraising Event for the National MS Society 5:38 Study Finds Most Relapsing-Remitting MS Disability Accumulation Is Progressive and Not Tied to Relapses 7:29 Survey Shows Most MS Patients Want to Discuss the Cost of MS Care...But Don't 9:50 "Patients" are Customers! 11:31 My Interview with Alexander Hardy 13:09 Share this episode 29:31 Please Support the National MS Society COVID-19 Response Fund 29:50 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/150 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.comPhone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com National MS Society's Ask An MS Expert Video Replay What You Need to Know About Coronavirus (COVID-19) National MS Society COVID-19 Response Fund To receive a free copy of Resilience in the Face of Multiple Sclerosis, just jump onto Twitter, and request your copy by sending a Tweet to the author, @Brandon_Beaber. CAN-DO MS Virtual Jumpstart Programs Longest Day of Golf Fundraising Event for the National MS Society STUDY: Contribution of Relapse-Independent Progression vs Relapse-Associated Worsening to Overall Confirmed Disability Accumulation in Typical Relapsing Multiple Sclerosis in a Pooled Analysis of 2 Randomized Clinical Trials STUDY: Perceptions and Experiences of Multiple Sclerosis Patients Regarding Out-of-Pocket Costs of Care Discussions Join the RealTalk MS Facebook Group Download the RealTalk MS App for iOS Download the RealTalk MS App for Android Give RealTalk MS a Rating and Review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 150 Hosted By: Jon Strum Guests: Alexander Hardy Tags: MS, MultipleSclerosis, MSResearch, MSSociety, Genentech, Ocrevus, Resilience, RealTalkMS Privacy Policy
May 1, 2020: Daily Corona Virus Press Briefing AMID ONGOING COVID-19 PANDEMIC, GOVERNOR CUOMO ANNOUNCES SCHOOLS AND COLLEGE FACILITIES STATEWIDE WILL REMAIN CLOSED FOR THE REST OF THE ACADEMIC YEAR Directs Schools and Colleges to Create Re-Opening Plans that Re-Imagine Facilities to Be Approved by the State State is Partnering with Kate Spade New York Foundation and Crisis Text Line to Provide 24/7 Emotional Support Service for Frontline Workers; Workers Can Text NYFRONTLINE to 741-741 Department of Financial Services to Require New York State-Regulated Health Insurers to Waive Out-of-Pocket Costs for Mental Health Services for Frontline Essential Workers Announces New Targeted Efforts to Further Reduce Number of New Hospitalizations per Day Five New Drive-Through Testing Facilities Now Open in Monroe, Erie, Broome, Niagara and Oneida Counties Confirms 3,942 Additional Coronavirus Cases in New York State - Bringing Statewide Total to 308,314; New Cases in 48 Counties
In the first segment, Dr. Jason Crowell talks with Dr. Daniel Hartung about his paper on the effect of generic glatiramer acetate on the reduction of MS costs. In the second part of the podcast, Dr. Jason Crowell speaks with Dr. Brian Callaghan about his paper—also from the March 31st issue of Neurology—on the association between out-of-pocket costs and adherence to common neurologic medications. Disclosures can be found at Neurology.org. CME Opportunity: Listen to this week’s Neurology Podcast and earn 0.5 AMA PRA Category 1 CME Credits™ by answering the multiple-choice questions in the online Podcast quiz.
Dr. Callaghan discusses his paper entitled, "Association of Out-of-pocket Costs on Adherence to Common Neurologic Medications" You can read the paper here: https://n.neurology.org/content/early/2020/02/18/WNL.0000000000009039
Host: Linda Bernstein, Pharm.D. On this episode of The Drug Report, pharmacist Dr. Linda Bernstein focuses on a recent CVS Health announcement of their new plan that allows employers and health plan sponsors to work within a formulary and plan design to offer all types of diabetes medications—including insulin—at zero-dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members.
Host: Linda Bernstein, Pharm.D. On this episode of The Drug Report, pharmacist Dr. Linda Bernstein focuses on a recent CVS Health announcement of their new plan that allows employers and health plan sponsors to work within a formulary and plan design to offer all types of diabetes medications—including insulin—at zero-dollar out of pocket for their members without raising costs for the plan sponsor or increasing premiums or deductibles for all plan members.
BackgroundJohn Lynch bio John Lynch research Center for Research on Consumer Financial Decision Making Academic Research Council, Consumer Financial Protection Bureau Financial EducationFernandes, Lynch, J.G., & Netemeyer, R.G. 2013. “Financial Literacy, Financial Education, and Downstream Financial Behaviors.” forthcoming in Management Science.“Examining Financial Education: How Literacy and Interventions Affect Financial Behaviors,” National Endowment for Financial Education, 2014. “Financial Literacy: Just-in-Time Is the Ticket,” Christine Benz and John Lynch, Morningstar.com, March 12, 2016. Thaler, R. 2013. “Financial Literacy: Beyond the Classroom.” The New York Times, Oct. 5, 2013. Kitces, M. 2016. “Financial Literacy Effectiveness and Providing Just-in-Time Training by Financial Advisors.” Nerd’s Eye View, Sept. 21, 2016. Ward, A.F. & Lynch, J.G. 2019. “On a Need-to-Know Basis: How the Distribution of Responsibility Between Couples Shapes Financial Literacy and Financial Outcomes.” Journal of Consumer Research, Vol. 45, No. 5, P. 1013. Retirement Planning and Financial OutcomesSammer, J. “Retirement Plans Are Leaking Money. Here’s Why Employers Should Care.” Society of Human Resources Management, Oct. 17, 2017. Nudge theory definition Thaler, R. & Sunstein C. 2008. “Nudge: Improving Decisions About Health, Wealth, and Happiness" (New Haven: Yale University Press).Wright, O. 2013. “How Organ Donation Is Getting Nudge in the Right Direction.” The Independent, Dec. 24, 2013. “How America Saves,” Vanguard, 2019. Financial Decision-Making and Well-Being“Four-Year Myth,” Lumina Foundation.Hunter, W.G., Zhang, C.Z., Hesson, A., et al. 2016. “What Strategies Do Physicians and Patients Discuss to Reduce Out-of-Pocket Costs? Analysis of Cost-Saving Strategies in 1,755 Outpatient Clinic Visits.” Society for Medical Decision Making, Vol. 36, No. 7, P. 900. Netemeyer, R., Warmath, D., Fernandes, D. & Lynch. J. 2017. “How Am I Doing? Financial Well-Being, Its Potential Antecedents, and Its Relation to Psychological/Emotional Well-Being.” Advances in Consumer Research, Vol. 45, P. 780. “Complaint Snapshot: Debt Collection,” Consumer Financial Protection Bureau, May 2018. Nova, A. 2019. “A $1,000 Emergency Would Push Many Americans Into Debt,” CNBC.com, Jan. 23, 2019.
Dr. Brian Callaghan talks about the rise in out-of-pocket costs for commonly prescribed neurologic medications.
In the first segment, Dr. Jason Crowell talks with Dr. Brian Callaghan about rising out-of-pocket costs for commonly prescribed neurologic medications. In the second part of the podcast, Dr. Jeffrey Ratliff focuses his interview with Dr. Stefan Pulst on ataxias. CME Opportunity: Listen to this week’s Neurology Podcast and earn 0.5 AMA PRA Category 1 CME Credits™ by answering the multiple-choice questions in the online Podcast quiz.
Joseph Nazarian shares tips and ideas that, if you or someone you know has been injured, you need to know! http://www.NazarianLawFirm.com
Episode 41: Passive Income with Minimal Out of Pocket Costs with Ryan Enk! This week on the podcast we have Ryan Enk; founder and host of the CashFlow DadLife podcast, investor, entrepreneur, and real estate mentor. He has bought and sold over 20 million in real estate and has coached many people on how to become financially free through… The post Episode 41: Passive Income with Minimal Out of Pocket Costs with Ryan Enk! appeared first on Flipping Real Estate Like The Pros.
There are constant headlines about how people are losing confidence in private health insurance. One reason is rising premiums but another is the gaps between what doctors charge you and what you get back from Medicare and your health fund. We asked you to send in your medical bills if you were upset about your out of pocket expenses and hundreds of you did. It was extraordinary and shocking. A urologist charging $27,000 for a prostatectomy. A potentially illegal under the counter fee of $6000. So it went on. Professor Stephen Duckett says the private system is under strain, and there's no easy fix on the horizon. Plus, men with slow-growing prostate cancers aren't being properly monitored and the evidence for a link between schizophrenia and urbanicity on shaky ground.
Every week, The American Journal of Managed Care® recaps the top managed care news of the week, and you can now listen to it on our podcast, Managed Care Cast. This week, the top managed care stories included another insurer announcing it would pass on drug rebates to consumers; FDA approved a new continuous glucose monitor and created a new medical device class; new guidelines address how to treat people with both HIV and cancer. Read more about the stories in this podcast: What We're Reading: Accidental Medicaid Enrollment; Cracking Down on Opioids; Passing on Drug Rebates: www.ajmc.com/newsroom/what-were-reading-accidental-medicaid-enrollment-cracking-down-on-opioids-passing-on-drug-rebatesUnitedHealthcare to Pass Drug Company Rebates Back to Consumers: www.ajmc.com/newsroom/unitedhealthcare-to-pass-drug-company-rebates-back-to-consumers Out-of-Pocket Costs for Insulin Are a Problem. Litigants in Case Disagree on Who Is at Fault: www.ajmc.com/newsroom/out-of-pocket-costs-for-insulin-are-a-problem-litigants-in-case-disagree-on-who-is-at-fault Brenda Schmidt Discusses Getting Ready for the Launch of Medicare DPP: www.ajmc.com/interviews/brenda-schmidt-discusses-getting-ready-for-the-launch-of-medicare-dpp FDA Approves Dexcom G6, Streamlines Review for Similar Interoperable CGMs: www.ajmc.com/newsroom/fda-approves-dexcom-g6-streamlines-review-for-similar-interoperable-cgms NCCN's New Guidelines Promote Better Cancer Care for People With HIV: www.ajmc.com/conferences/nccn-2018/nccns-new-guidelines-promote-better-cancer-care-for-people-with-hiv Institute for Value-Based Medicine—Advancing Quality in Oncology Care: www.ajmc.com/ivbm-registration
Become an expert on Part D Prescription Plans! We break down what these plans include, tips on how to sell them, and more! Read the text version. Mentioned in this Episode: 10 Essential Facts About Medicare and Prescription Drug Spending2018 Medicare Part D OutlookCDC: Health, United States, 2016Facts About Seniors and Senior CareIt Pays to Shop: Variations in Out-of-Pocket Costs for Medicare Part D Enrollees in 2016Retail Prescription Drugs Filled at Pharmacies (Annual per Capita by Age) Related: 7 Powerful Practices for Selling Prescription Drug PlansThe Part D SEP Triggers That Can Help You Post-AEPWhat Seniors Value Most in an MA Plan Subscribe Here: Apple PodcastsGoogle PodcastsOvercastPodbeanSpotifyStitcher Connect With Us: FacebookTwitterYouTubeLinkedIn
When buying a home, there are four out-of-pocket expenses that you should be prepared to pay: Selling a home? Get a free home value report Buying a home? Search all homes for sale 1. Your due diligence deposit. Our purchase contract was revised a few years ago and now stipulates that the buyer make a non-refundable due diligence deposit to the seller. This deposit does credit back to the transaction as long as you make it to the closing table. The due diligence deposits can range anywhere from $500 to several thousand dollars, depending on the price of the property and the competitive pressure against the property. 2. The earnest money deposit. This is another deposit from the buyer to the seller, in addition to the due diligence deposit. Like the due diligence deposit, the earnest money deposit credits back to the transaction at closing. The earnest money deposit can range from $1,000 to several thousand dollars, again depending on the price of the property and the amount of pressure on the property at the time of contract. 3. Home inspections. A general inspection, termite inspection, and radon inspection are the big three that you’ll want to order. Home inspections range from $700 to $800 overall. That said, there may be additional inspections required based on what the initial inspections find. If the property has a well or septic tank, those require their own inspections. Generally, though, expect to pay $700 to $800. Those expenses can be moved to the settlement statement, but it’s good to know that amount up front for planning purposes. 4. Other fees and service costs. Depending on your lender, you will have to pay some costs for the appraisal process, application fee, and more. These other services usually cost a few hundred dollars. “THE EARNEST MONEY DEPOSIT CREDITS BACK TO THE TRANSACTION AT CLOSING.” These are the four main costs that you should plan for when buying a home. If you have any other questions about the home buying process or our current real estate market, just give me a call or send me an email. I would be happy to help you!
In this episode Yolanda Penders (End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium) presents a study which aimed to investigate the self-reported out-of-pocket costs associated with healthcare in the last year of life of older adults in Europe. Full paper from:http://pmj.sagepub.com/content/early/2016/04/27/0269216316647206.abstract
Guest: Dr. Yousuf Zafar, gastrointestinal medical oncologist and health services researcher at the Duke Cancer Institute, and co-author of "Full Disclosure — Out-of-Pocket Costs as Side Effects". His research explores ways to improve care delivery for patients with cancer. His primary area of interest is in the cost of cancer care. He has conducted institutional and national studies on how treatment-related costs impact cancer patients' experience. His current work focuses on how the cost of care can drive medical decision-making and impact the physician-patient relationship. (For a copy of this interview go to www.w4tsr.com, click on Joni Aldrich, episode 12/9/13) Listen to Joni live M-F at 2:00 p.m. ET on www.W4CS.com. To learn more about Joni, go to www.JoniAldrich.com
Dr. Peter Ubel is Professor of Business Administration and Medicine and of Public Policy at Duke University. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. P.A Ubel, A.P. Abernethy, and S.Y. Zafar. Full Disclosure - Out-of-Pocket Costs as Side Effects. N Engl J Med 2013;369:1484-6.
For this episode, I read the entire Patient Protection and Affordable Care Act. The following is a resource for finding information within the Patient Protection and Affordable Care Act. My goal was to highlight the portions of the bill that will most directly affect our lives and put them into plain, understandable English. I'd also like for you to be able to find the text that makes these rules within the bill. The easiest way to search within a bill is by section number. You'll have to read a bit to find exactly what you're looking for, but this outline will tell you which section you can find the different provisions in. Anything "in quotes" is exact text from the bill. There are two versions of the Patient Protection and Affordable Care Act (Public Law 111-148) you can read. This version is 906 pages. This version is 2,409 pages (the margins and the font are bigger). If you are going to attempt to read the Patient Protection and Affordable Care Act, you must know that Title X amends the first nine titles and The Reconciliation Act amended the whole bill. This means that the law is often not what the text says. Here is a section by section summary of the changes made by Title 10 and the Reconciliation Act. This document was provided to the United States Senate for clarification. TITLE I: "QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS Subtitle A: "Immediate Improvements in Health Care Coverage for All Americans" Section 1001: Rules on health insurance minimums that became effective immediately Insurance company can't drop you when you get sick, unless you committed fraud Health insurance plans have to provide - at no extra charge: All of the preventatives services on this list Immunizations Preventative care screenings for kids Kids can stay on their parent's insurance plans until their 26th birthday Insurance companies must cover at least 60% of medical payments The health insurance companies need to provide customers with a summary of benefits, which can only be 4 pages long with a minimum of 12-pt font and must include limitations, co-payments, deductibles, and percentage of medical costs covered by the insurance company. If they fail to provide the summary, the health insurer has to pay $1,000 for each customer who didn't receive it Employers are not allowed to only offer coverage to their high-paid employees Section 1001 as changed by amendment (See Section 10101): No lifetime limits or "unreasonable annual limits" on the value of benefits for any customer They can place limits on things that are not essential health benefits Gun ownership health dangers must be ignored: Prevention programs can not collect information related to the presence of guns or ammunition in someone's home Premium rates can not be affected by the presence of a gun in someone's home Medical Loss Ratio Health insurance companies covering large groups must spend 85% of your premiums on you, or they have to issue a rebate check. Health insurance companies covering people in the individual market or small groups through exchanges have to spend 80% of your premiums on you or issue a rebate check. Hospitals must publish a list of standard charges for their services. Health insurance companies have to let you go to any primary care doctor that you choose and who can accept you The insurance company must have an appeals process for customers and must continue coverage while claims are in appeals If you get treatment in an out-of-network emergency room, your health insurance has to pay for those services. Health insurance companies can't require prior approval for emergency services. Health insurance companies can not require advance approval to go to get gynecological services. Section 1003: Premium Increase Reviews The Federal government and the States will review annual premium increases. States can recommend that a health insurance company be excluded from the exchange for unjustified premium increases. Subtitle B: "Immediate Actions to Preserve and Expand Coverage" Section 1101: Creates the "high risk health insurance pool program" to cover people with pre-existing conditions until January 1, 2014 Could only be run by non-profit private insurers or States Insurer had to cover at least 65% of customer's medical costs Could vary premiums based on age no more than a 4:1 ratio Only open to United States citizens or lawful residents who had no health insurance for the 6 months prior to enrollment Provided $5 billion (this money ran out & the government stopped accepting new applicants on February 15, 2013 - the House Republicans would have added money only if the Public Health fund were defunded, as explained in episode CD026) High risk pool ends on January 1, 2014 and customers will then buy their insurance on the exchanges, when health insurers will not be allowed to deny them coverage anymore Section 1102: Reimbursement for employers who give health coverage to "early retirees" Employers who provide health insurance to people over 55 years old but under 65 (when Medicare kicks in) will be reimbursed for a portion of that expense. Payments will be 80% of the amount over $15,000 up to $90,000. Payments must be used for health care expenses & can not be used as general revenue or count as income. Provided $5 billion for this program Program ends on January 1, 2014, when everyone can buy insurance on the exchanges Section 1104: Orders the Secretary of Health & Human Services to develop "uniform standards" for health information electronic data entry The rules will be for communication between hospitals/doctors and the health insurance companies. Allows for the creation of "machine readable identification cards" Penalty fee will be assessed beginning on April 1, 2014 for health insurance companies that don't comply Fee is $1 per customer covered until they've completed the electronic information requirements. The fee is imposed for each day the plan is not in compliance. The fee is increased annually and capped at $20 per customer or $40 per customer if the insurance company purposely provides false or incomplete information. Penalty fees are paid to the Treasury Department and are due November 1 of each year starting in 2014. Subtitle C: "Quality Health Insurance Coverage for All Americans" Section 1201: Health Insurance Market Reforms Health insurance companies can not exclude someone for having a pre-existing condition This law became effective for children starting six months after the Affordable Care Act was signed Premium rates are allowed to vary based on the following factors only: The number of people covered by the plan (individual or family) Location Age, but the rate can not vary more than a 3:1 ratio for adults Tobacco use, but the rate can not vary more than a 1.5:1 ratio Health insurance companies must accept every employer or individual customer who applies for coverage during their open enrollment periods. Health insurance companies can not deny a customer coverage due to health status, mental or physical illnesses, history of claims, medical history, genetic information, domestic violence history, disability, or any other health-related factor. Health insurance companies also have to renew your insurance policy Health insurance companies can offer rebates or premium discounts as a reward to customers' participation in wellness programs including: Reimbursement for fitness center memberships A disease testing program that does not base the reward on outcomes Waiving co-payments or deductibles for preventative care visits (prenatal care & well-baby visits) Reimbursement for programs that help people quit smoking, regardless of whether or not they can actually quit A reward for attending health education seminars Waiting periods can not be longer than 90 days This does not apply to the individual market (added by Section 10103) Section 1201 as changed by amendment (See Section 10103) Health insurance companies can't deny coverage for approved clinical trials for treatment of cancer or another life-threatening disease. Section 1251: Grandfathered health care plans Nothing in the Affordable Care Act forces an individual to cancel the coverage they currently have. Grandfathered plans are exempt from the provisions of Subtitle A and Subtitle C, except for the provisions specifically listed below. New employees and their families can be enrolled in health plans that existed before the Affordable Care Act was enacted. Section 1251 as changed by amendment (See Section 10103) Grandfathered plans must provide the easily understood summary of benefits from Section 1001 to their customers. Grandfathered plans must issue rebate checks under the Medical Loss Ratio just like new plans Health insurance companies covering large groups must spend 85% of your premiums on you, or they have to issue a rebate check. Health insurance companies covering people in the individual market or small groups through exchanges have to spend 80% of your premiums on you or issue a rebate check. Section 1251 as changed by the Reconciliation Act (See Public Law 111-152) Grandfathered plans are prohibited from enforcing waiting periods over 30 days. Grandfathered plans are prohibited from enforcing lifetime or annual limits to coverage (group plans only). Grandfathered plans can not drop you when you get sick. Grandfathered plans will also have to cover children until their 26th birthday. Grandfathered plans can not refuse an employee with pre-existing conditions. Subtitle D: "Available Coverage Choices for All Americans" Section 1302: Essential Health Benefits Requirements Essential health benefits to be included in all "qualified health plans": Ambulances Emergency room services Hospitalizations Maternity and newborn care Mental health Substance abuse treatment Behavioral health treatment Prescription drugs Rehabilitation services and devices Laboratory services Preventative care Chronic disease management Pediatric care, including dental and vision Health insurance companies are allowed to cover more than these minimums Coverage for emergency services can not require prior authorization Health insurance companies can't limit coverage because the ambulance took you to an out-of-network emergency room Out of pocket expense caps In 2014, an individual can not be charged more than $5,000/year for out-of-pocket expenses (not including premiums); after that, it can be increased by the same percentage as premium increases. Deductibles for employer-paid plans are capped at $2,000/year for individuals or $4,000/year for family plans. After 2014, these numbers can be increased by the same percentage as premium increases. Out-of-pocket caps do not include amounts for non-network providers or non-covered services Levels of Coverage Bronze: Covers 60% of medical costs Silver: Covers 70% of medical costs Gold: Covers 80% of medical costs Platinum: Covers 90% of medical costs Catastrophic Coverage available only on the individual market Plan provides no benefits until the person has spent the $5,000/year out-of-pocket limit (or whatever the limit is for that year, adjusted for inflation) Available only to people under 30 years old Available only if a monthly premium would exceed 8% of that person's income Section 1303 as changed by amendment (See Section 10104): Abortion Rules States can prohibit abortions from being offered by health insurance plans offered through the exchange. States must pass a law to do this. Health insurance plans do not need to include abortions. No Federal funds can be used to pay for abortions. No hospital or doctor's office can be discriminated against by insurance companies for not providing abortions. Section 1311: Health Insurance Exchanges States will be given Federal grants to set up their own health insurance exchanges, which are websites where people will compare and purchase their insurance plans. Grants will stop being awarded on January 1, 2015. Exchanges will include an "enrollee" satisfaction system for plans covering more than 500 people. Secretary must determine yearly open enrollment periods Stand-alone dental plans will be allowed on the exchanges. States are allowed to require more benefits than the Federal government requires, but must make up cost to individuals for extra costs if they're eligible for a tax credit. By 2015, exchanges must be self-sustaining and can charge user fees. Exchanges have to publish all payments required by the Exchange & the administrative costs. Interstate and regional exchanges are allowed. Creates "navigator" positions They will inform the public on the health plans, help people enroll, and help people understand their tax credits. Navigators are not allowed be employees of the health insurance industry Section 1311 as changed by amendments (See Section 10104) Health insurance companies need to publicly disclose - in plain language - information on claims payment policies, enrollment, denials, out-of-network charges, and customer rights. Section 1312: Health Insurance Eligibility & Members of Congress All customers in with a company's individual plan will be considered part of a one risk pool. All customers enrolled as employees of small businesses will be considered part of one risk pool. The individual and small business pools may be merged if the State determines it appropriate. Starting in 2017, States can permit large employers (over 101 employees) to offer insurance through the Exchange. Health insurance companies can offer insurance outside of the Exchanges. Only United States citizens and lawfully present foreigners will be allowed to purchase health insurance on the Exchange. Prisoners will not be eligible to buy insurance on Exchanges while they're still incarcerated The Federal Government can only offer health plans to members of Congress that are offered through an Exchange. Section 1312 as changed by amendment (See Section 10104) Agents and brokers are allowed to enroll employers and individuals in health insurance plans and help them apply for tax credits and out-of-pocket reductions. Section 1321: States Must Create Exchanges or Federal Government Will Do It For Them Department of Health and Human Services will provide an exchange for a State if the State will not have it's own operational by January 1, 2014. Section 1322: Grants for Creation of Non-Profit, Member-Run Health Insurance Companies The goal is to have at least one non-profit, member-run health insurance company in each State offer insurance on the individual and small business exchanges. If a State doesn't have a non-profit, member-run option, they will be loaned money to create one or to have one from elsewhere expand into their State. The loan must be repaid within 15 years (added by Section 10104) The non-profit, member-run health insurance companies are not allowed to use Federal funds for marketing. A health insurance company will not count as a non-profit, member-run insurance company unless "any profits made by the organization are required to be used to lower premiums, to improve benefits, or for other programs intended to improve the quality of health care delivered to its members." Non-profit, member-run health insurance companies will be tax exempt. Section 1323: Optional State Public Option (Killed by amendment: See Section 10104) States are allowed to offer a public option, labeled "community health insurance", but they are not required to. Section 1331: States Can Buy Insurance for Low-Income People Who Don't Qualify for Medicaid or Medicare To qualify for this program, if offered by your State: Must be a resident of the offering State Must be under 65 years old Your income needs to be between 133%-200% of the poverty level Section 1332: Waiver for States That Develop A Better System States that develop a system that covers as much and costs the same or less than the Federal system can apply for a waiver. If granted, they can enact their own system. The new system could begin on January 1, 2017. Section 1333: Allows Health Insurance Plans to Be Sold To Multiple States Health insurance companies would have to be licensed in all the States where its plans are sold. Health insurance companies would have to "clearly notify consumers that the policy may not be subject to all the laws and regulations of the State in which the purchaser resides." Plans sold in multiple states - "health care choice compacts"- can begin on January 1, 2016. Section 1334 as added by amendment (See Section 10104): National Health Insurance Plans The Director of the Office of Personnel Management will contract with at least two insurance companies to offer insurance to the individual and small group markets in every state. At least one of these companies must be non-profit. Plans need to be licensed in each State where they offer coverage. States can require health insurance companies to offer additional benefits but must pay the additional cost. The multi-state insurance plans will be nationwide within four years. Section 1341: Insurance Companies Will Have Insurance for "High-Risk" Customers for First 3 Years Subtitle E: "Affordable Coverage Choices for All Americans" Section 1401 as amended by Section 1001 of the Reconciliation Act: Tax Credits Taxpayers Making Between 100% - 400% of the Poverty Level Get Tax Credits To Pay for Premiums The tax credit is for the amount the health insurance plan exceeds a percentage of a person's income, based on the poverty level. The premium used for calculation is the second-lowest silver plan in the individual market where the taxpayer lives. Section 1402: Out-of-Pocket Limits Reduced Only applies to people who have purchased Silver Level coverage on an Exchange The standard out-of-pocket limits ($5,950 for individuals and $11,900 for families) would be reduced for people making under 400% of the poverty level. Reduction Levels: People making 100%-200% of the poverty level will have their limit reduced by 2/3. People making 201%-300% of the poverty level will have their limit reduced by 1/2. People making 301%-400% of the poverty level will have their limit reduced by 1/3. No health insurance company will ever pay more than 94% of medical costs (increased by Section 1001 of the Reconciliation Act). The Federal Government will pay the health insurance companies for the amount they reduce out-of-pocket limits Illegal immigrants are not eligible. *Tax Credit / Premium Calculator Section 1411: How Government Will Determine Eligibility & Grant Individual Exemptions People or employers who disregard regulations and provide false information are subject to a $25,000 fine. People or employers who purposefully provide false information are subject to a $250,000 fine. No property can be taken away if the person or company doesn't pay the penalty. Section 1412: Advance Payment of Tax Credits and Out-of-Pocket Reductions Premium tax credits can be claimed in advance to help pay for premiums. Section 1415: Premium Tax Credits Don't Count As Income Section 1421 as changed by amendment (See Section 10105): Small Business Tax Credit Eligible employers must: Have fewer than 25 employees and Pay average annual wages of less than $50,000/year. Pay at least 50% of total premiums. Eligible employers who purchase coverage through the State exchange can get a tax credit of up to 50% of their health insurance costs. Tax-exempt eligible employers can get a tax credit of up to 35% of their health insurance costs. Subtitle F: "Shared Responsibility for Health Care" Section 1501 as changed by amendment (See Section 10106): The Individual Mandate Individuals must ensure that they and their dependents have health coverage every month starting in 2014. If individuals fail to get themselves and their dependents covered, they will pay a penalty for each month they and their dependents were uncovered. (see Section 1002 of the Reconciliation Act) The penalty in 2014 will be $95 or 1% of income, whichever is higher The penalty in 2015 will be $325 or 2% of income, whichever is higher The penalty in 2016 and after will be $695 or 2.5% of income, whichever is higher. Penalties are capped at the cost of the national average for a bronze plan premium. Exemptions are allowed: For people in an exempt religious sect For members of a health care sharing ministry For Native Americans For people below 100% of the poverty level who can't afford available health insurance options People who have a coverage gap of less than three months (if the gap goes longer than three months, they get no exemption for any of that time) People who have proven to the Department of Health and Human Services that they have an extraordinary hardship. You can not be criminally prosecuted, thrown in jail, or have your property taken away if you fail to pay the penalty. Section 1502: Health Insurance Companies Will Report Your Coverage Status to the Government Every year, the Treasury Department will send notices to people who didn't get coverage telling them what is available to them on their State's exchange. Section 1503: Automatic Enrollment for Workers with Large Employers Companies with over 200 employees will automatically enroll their new full-time employees in one of the health plans they offer. Employees are allowed to opt out of their employer provided coverage. Section 1512: Workers Must Be Informed of Better Options If a company's health insurance plan doesn't cover at least 60% of medical expenses, the worker might be eligible for premium tax credits and out-of-pocket limit reductions. Companies need to inform their workers about the exchanges and provide a description of the exchange's services. Section 1513 as amended by Section 1003 the Reconciliation Act: Employers With Over 50 Employees Starting January 1, 2014, they must offer their employees health insurance. If one or more of their employees received tax credits or an out-of-pocket limit reduction on the exchange, the employer will be fined $2,000 per full-time employee. They will not have to pay the penalty for the first 30 full-time employees. If the employer offers health insurance but the employee claims tax credits and/or out-of-pocket limit reductions on the exchange, the employer will be charged either $3,000 per employee receiving tax credits or $2,000 per full-time employee minus the first 30 employees, whichever is less. Employers can not have waiting periods for health coverage of over 60 days. (Eliminated by the Reconciliation Act) Fines are not tax deductible. Seasonal workers - that work less than 120 days per year -do not count as full-time employees. Section 1514: Large Employers Must Report Your Coverage Status to Government Section 1553: No One Can Discriminate Against Anyone Else For Not Providing Doctor Assisted Suicide Section 1558: Protection For Employees Employers may not fire or discriminate against any worker who reports, testifies, or helps the government prosecute an employer that has violated the Affordable Care Act. Section 1560: Hawaii Can Keep Its Health Care System Section 1563: CBO Estimates The Affordable Care Act Will Reduce Budget Deficits TITLE II: "ROLE OF PUBLIC PROGRAMS" Subtitle A: Improved Access to Medicaid Section 2001 as amended by Section 10201: Medicaid for Poor People Starting in 2014, anyone making under 133% of the Federal Poverty Level will be eligible for Medicaid's health benefits. Medicaid's health benefits will include the essential benefits required of all health insurance plans on exchanges, prescription drugs, and mental health services. The Federal Government will pay States for the new Medicaid expenses at the following rates (changed by Section 1201 of the Reconciliation Act): 100% for 2014-2016 95% for 2017 93% for 2019 90% for ever *The June 28, 2012 Supreme Court ruling effectively made the Medicaid expansion optional for the States. The result is that unfortunate souls making under 133% of the Federal Poverty Level and living in States that have turned down the Federal Government money will not have health care coverage. Via: The Advisory Board Company Section 2004 as amended by Section 10201: Medicaid for Foster Children Beginning in 2014, States must cover former foster children in their Medicaid programs Subtitle B: "Enhanced Support For the Children's Health Insurance Program" Section 2101: Federal Financing of Children's Health Insurance Program (CHIP) Federal Government will increase its contribution to States' CHIP programs by 23%, funding up to 100%. Subtitle C: "Medicaid and CHIP Enrollment Simplification" Section 2201: Electronic Enrollment By January 1, 2014, States must create websites that allow individuals to apply and enroll in Medicaid and CHIP States that fail to create the website will lose their Federal Medicaid money. Section 2202: Hospital Enrollment in Medicaid Allows hospitals to determine whether a person qualifies for Medicaid based on preliminary information in order to provide them with medical assistance. Subtitle D: "Improvements to Medicaid Services" Section 2301: Free-Standing Birth Centers Requires Medicaid cover services from free-standing birth centers. Section 2303: Family Planning Services States can, but don't have to, provide family planning services as part of Medicaid. Subtitle E: "New Options for States to Provide Long-Term Services and Supports" Section 2401: At Home Services Option Allows States to cover at home services - the kind that would usually be offered in an institution - to people under 150% of the poverty level. Subtitle F: "Medicaid Prescription Drug Coverage" Section 2501: Prescription Drug Rebates Increases rebates for prescription drugs up to 100% of the cost of the drug. Section 2502: Additional Drugs Covered Drugs to help quit smoking, barbiturates, and benzodiazepines will be covered by Medicaid starting on January 1, 2014. Subtitle G: "Medicaid Disproportionate Share Hospital (DSH) Payments" Section 2551: Payment Reductions Reduces Federal payments to certain hospitals. Subtitle H: "Improved Coordination for Dual Eligible Beneficiaries" Section 2602: Medicaid and Medicare Coordination Creates a Federal Coordinated Health Care Office to coordinate the benefits of individuals who qualify for both Medicaid and Medicare. Subtitle I: "Improving the Quality of Medicaid for Patients and Providers" Section 2703: Care for Medicaid Patients with Chronic Conditions Gives States the option to create teams of health professionals to manage care for Medicaid patients with chronic conditions. Chronic conditions include: Mental health disorders Substance abuse issues Asthma Diabetes Heart Disease Obesity Subtitle K: "Protections for American Indians and Alaska Natives" Section 2901: No Out-of-Pocket Costs for Certain Indians Indians at or below 300% of the Federal Poverty Level will not have to pay out-of-pocket costs for insurance they get through a state exchange TITLE III: IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE Subtitle A: "Transforming the Health Care Delivery System" Section 3001: Links Hospital Payments to Performance Starting in 2013, a percentage of hospital payments will be tied to performance in treating common high-cost conditions (cardiac issues, surgeries, pneumonia, etc.) Section 3007: New System for Physician Payments Secretary of Health and Human Services must create a new budget-neutral payment system that will adjust Medicare payments to physicians based on the quality of care they deliver. New system will be phased in over two years beginning in 2015. Section 3008: Penalties for Poor Performance Hospitals in the top 25th percentile for rates of diseases caught inside the hospital will have a payment penalty through Medicare. Section 3011: National Strategy Secretary of Health and Human Services has to establish our national strategy to improve health care delivery and overall population health. Section 3025: Readmissions Reduction Ties Medicare payments to hospitals with the hospitals percentage of potentially preventable readmissions to the hospital. The Secretary of Health and Human Services will make readmission rates for certain conditions at every hospital available to the public. Subtitle B: "Improving Medicare for Patients and Providers" Section 3112: Eliminates "Medicare Improvement Fund" Saves over $22 billion Rest of Subtitle creates new systems and changes the way Medicare charges paid for by the government. Subtitle C: "Provisions Related to Part C" Section 3201: Limited Medicare Advantage Payments (Killed by Section 1102 of the Reconciliation Act) Section 3202: Prevents Private Medicare Advantage Plans from Overcharging Prohibits private Medicare Advantage plans from charging more for basic Medicare services than actual Medicare charges. Medicare Advantage plans that offer extra benefits must prioritize reductions in out-of-pocket expenses and preventative care over their extra goodies. Section 3204: Seniors Can Return to Actual Medicare Seniors will be allowed to unenroll in their Medicare Advantage plans and return to real Medicare from January 1-March 15 of every year. Section 3209: Medicare Advantage Plan Denial Allowed Secretary of Health and Human Services now has the authority to prohibit Medicare Advantage plans that significantly increase cost to customers or decrease benefits offered to seniors. Subtitle D: "Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans" Section 3301: Donut Hole Discount Program Medicare Part D private insurance plans pay 75% of drug costs up until $2,970 is spent and then start paying 95% once the senior has spent $4,750. Between $2,960 and $4,750, the insurance company pays nothing. This window is known as the "coverage gap" or "donut hole". This section requires drug manufacturers provide a 50% discount for brand name drugs for seniors while paying out-of-pocket for drugs in the coverage gap. Even though they only pay 50% of cost, the full price of the drug will count as paid so that they get out of the coverage gap sooner. The Secretary of Health and Human Services was put in charge of implementation. Section 1101 of the Health Care and Education Reconciliation Act Provides a $250 rebate to seniors who enter the "coverage gap""donut hole". Closes the Medicare Part D "coverage gap" "donut hole" by 2020. Section 3308: Reduces Medicare Subsidy for High-Income Seniors Section 3311: Medicare Advantage & Medicare Part D Complaint System Secretary of Health and Human Services will create a system so that seniors can submit complaints about the private Medicare Advantage and Medicare Part D drug plans Subtitle E: "Ensuring Medicare Sustainablity" Section 3401: Changes Payment Structures for Medicare Payments Section 3402: Freezes Premiums for High Income Seniors at 2010 Levels until 2019 Section 3403: Independent Payment Advisory Board (IPAB) Creates a 15 member board to propose ways to reduce the growth of Medicare spending. The board's recommendations will not go into effect during years that the Medicare growth rate is under control. The board will make non-binding recommendations during years when the Medicare growth rate is under control (added by Section 10320). The board is not allowed to propose anything that rations care, raises taxes, raises premiums for actual Medicare, increases out-of-pocket expenses for seniors, or reduces benefits. The board's suggestions will take effect unless Congress enacts alternative legislation that achieves the same level of savings. Subtitle F: "Health Care Quality Improvements" Provides funding for a variety of programs. Subtitle G: "Protecting and Improving Guaranteed Medicare Benefits" Section 3601: Nothing in This Law Can Cut Medicare Benefits Section 3602: Nothing in This Law Can Cut Medicare Advantage Benefits TITLE IV: PREVENTION OF CHRONIC DISEASE AND IMPROVING PUBLIC HEALTH Subtitle A: "Modernizing Disease Prevention and Public Health Systems" Section 4002: Prevention and Public Health Fund Will provide $2 billion a year (starting in 2015) for public health programs that include research, health screenings, and immunizations. Subtitle B: "Increasing Access to Clinical Preventative Services" Section 4103: Free Wellness Plan for Medicare Seniors Seniors will get a physical their first year on Medicare and risk assessments every year following without having to pay a co-pay or deductible. Section 4107: Help to Quit Smoking for Pregnant Women on Medicaid States must provide counseling and products to help pregnant woman on Medicaid quit smoking with no out-of-pocket costs. Subtitle C: "Creating Healthier Communities" Section 4205: Nutrition Labeling at Chain Restaurants Chain restaurants with 20 or more locations have to provide the number of calories (or a calorie range for combo meals) on menus, boards, and drive-thru boards. Upon request by a customer, they must be able to provide calories from fat, saturated fat, cholesterol, sodium, total carbohydrates, sugars, fiber, and protein. Section 4207: Break Time for Nursing Mothers Employers must allow nursing mothers break time to milk themselves. The employers do not have to pay the mothers for that time. Employers with under 50 employees are exempt. Subtitle D: "Support for Prevention and Public Health Innovation" Funds research and other programs. TITLE V: HEALTH CARE WORKFORCE Subtitle A: "Purpose and Definitions" Subtitle B: "Innovations in the Health Care Workforce" Creates a commission and provides grants. Subtitle C: "Increasing the Supply of the Health Care Workforce" Section 5201: Federally Funded Medical Student Loans Federal government will help pay medical student loans if the student agrees to practice as a primary care physician for 10 years. Decreases the penalty for students who don't comply. Section 5202: Increases Student Loan Amounts for Nursing Students Section 5203: Federal Government Loan Payback for Pediatric Medicine Students If the student agrees to work full-time providing pediatric services, the Federal government will help pay their student loans up to $35,000 a year. Section 5204: Federal Government Service in Return For Loan Repayment If a medical student agrees to work for the government for 3 years or longer, the government will pay up to $35,000 of that student's loans. Subtitle D: "Enhancing Health Care Workforce Education and Training" Subtitle E: "Supporting the Existing Health Care Workforce" Subtitle F: "Strengthening Primary Care and Other Workforce Improvements" Subtitle G: "Improving Access to Health Care Services" Section 5601: Provides Funding for Community Health Centers TITLE VI: TRANSPARENCY AND PROGRAM INTEGRITY Subtitle A: "Physician Ownership and Other Transparency" Section 6001: New For-Profit Doctor-Owned Hospitals Can Not Participate in Medicare Section 6002: Reporting on Industry Payments to Doctors Starting on March 31, 2013, pharmaceutical companies and manufacturers must report any kind of payments that they make to doctors. Manufacturers must report any ownership or investment relationships their doctor customers have with the company. Penalties for not reporting Between $1,000 an $10,000 for each payment that was not reported, capped at $150,000. If the manufacturer knowingly failed to report a payment, the penalty is $10,000-$100,000 for each payment that was not reported, capped at $1,000,000. The payment information reported on by manufacturers must be posted on a searchable website by September 30, 2013 (this has been delayed one year). Section 6004: Reports on Prescription Drug Samples Drug manufacturers and distributors must report the identity and quantity of drug samples requested and distributed every year. Section 6005: Pharmacy Reports Pharmacies need to report on their generic drug dispensing rate, rebates, discounts, and price concessions. Subtitle B: "Nursing Home Transparency and Improvement" Section 6103: Nursing Home Comparison Website The Department of Health and Human Services will operate a website that will allow customers to compare nursing homes by providing staffing data, certifications, complaints, and criminal violations. Section 6105: Creates a Standard Complaint Form Section 6111: Penalties Reduced for Self Reporting Secretary of Health and Human Services will be allowed to reduce penalties by 50% for facilities that report their own violations Subtitle C: "Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long Term Care Facilities and Providers" Section 6201: Background Checks Secretary of Health and Human Services will establish a system for doing background checks that include fingerprints on employees of long term care facilities. Subtitle D: "Patient Centered Outcomes Research" Subtitle E: "Medicare, Medicaid, and CHIP Program Integrity Provisions" Section 6401: Provider Screenings Secretary of Health and Human Services must establish procedures for screening providers and suppliers for Medicare, Medicaid, and CHIP All screening will include license checks Secretary can impose additional screenings including fingerprinting, background checks, and random visits. Providers and suppliers will have to report shady affiliations, suspended payments, if they're excluded from other Federal programs, and/or if they've had their billing privileges revoked. There will be an application fee of $200 for individual doctors and $500 for institutions every five years. Section 6404: Medicare Claims Must be Made Within 12 Months Section 6407: Physicians Must Have Face-to-Face Meeting With Patient Before Certifying Home Services Section 6411: Recovery Audit Contractors Secretary of Health and Human Services will establish contracts with auditors who will identify under and overpayments and collect overpayments for Medicaid services. The Secretary is required to include Medicare Advantage and Medicare Part D. Subtitle F: "Additional Medicaid Program Integrity Provisions" Section 6501: Medicaid Termination States must terminate a Medicaid program if they were kicked out of Medicare or another State's Medicaid program. Section 6502: Medicaid Exclusions Medicaid must exclude an individual or company that owns or manages something that: Has unpaid overpayments Is suspended or excluded from participation Is affiliated with someone who is suspended or excluded from participation Section 6505: No Payments Can Go Outside of the United States Subtitle G: "Additional Program Integrity Provisions" Section 6601: Prohibits False Statements Insurance company employees can be prosecuted and sentenced up to 10 years in prison and fined if they lie about the plan's financial solvency, benefits, or regulatory status. Subtitle H: "Elder Justice Act" TITLE VII: IMPROVING ACCESS TO INNOVATIVE MEDICAL THERAPIES Subtitle A: "Biologics Price Comparison" Subtitle B: "More Affordable Medicines for Children and Underserved Communities" TITLE VIII: "CLASS ACT"(Repealed) TITLE IX: "REVENUE PROVISIONS" Section 9001 as amended by Section 1401 of the Reconciliation Act: Excise Tax on High-Cost Employer Paid Insurance Plans Starting in 2018, there will be a on insurance companies for any health plan that costs more than $10,200 for single coverage and $27,500 for family coverage. The tax is 40% of the amount of the premium above $10,200 and $27,500. The tax begins at $11,850 for individuals and $30,950 for families for plans covering people over 55 and in high risk professions. The tax does not apply to plans sold on the individual market; it only applies to employer paid plans. The tax does not apply to stand alone dental or vision plans. Section 9002: Employer-Paid Health Benefits Will be Included on W-2 Forms Section 9008 as amended by Section 1404 of the Reconciliation Act: Pharmaceutical Industry Fee A fee of at least $2.8 billion a year will be divided by market share and paid by pharmaceutical manufacturers and distributors. Section 9009 as amended by Section 1405 of the Reconciliation Act: The Medical Device Tax There will be a 2.3% deductible tax on the sale of medical devices to be paid by the manufacturer or importer. The tax is not applied to items sold directly to the public such as eyeglasses, contacts, etc. Section 9010 as amended by Section 1406 of the Reconciliation Act: Tax on Health Insurance Companies A non-deductible fee will be divided amongst all health insurance companies based on market share every year. The fee will not apply to insurance companies that make less than $50 million in net premiums. The fee will not apply to government or employers. Non-profits who get more than 80% of their money from government programs are exempt. The fee is: $8 billion in 2014 $11.3 billion in 2015-2016 $13.9 billion in 2017 $14.3 billion in 2018 2019 and beyond: The previous year's fee increased by the rate of premium growth Section 9012: Eliminate Incentives For Employers to Enroll in Medicare Part D Section 9013: Raises Threshold for Medical Expenses Deduction Increases from 7.5% to 10% Individuals over 65 can claim the deduction at 7.5% until 2016 Section 9014 as changed by amendment (See Section 10906): Tax on Wealthy Increases the hospital insurance tax on people earning over $200,000 a year individually or $250,000 married couples filing together by 0.9%. Section 9014 as changed by Section 1402 of the Reconciliation Act: Tax on Wealthy Wall Street Income The hospital insurance tax will include a 3.8% tax on income from interest, dividends, annuities, royalties, and certain rents on people earning over $200,000 a year individually or $250,000 married couples filing together. Section 9017 as changed by amendment (See Section 10907): Tax on Elective Medical Procedures Indoor Tanning There will be a 5% tax on elective cosmetic surgery There will be a 10% tax on indoor tanning services. TITLE X: STRENGTHENING QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS Buried in Section 10104: Dismissal of Fraud Cases Changes Section 3730(e) of title 31, United States Code which determines how we prosecuted people who commit fraud, by eliminating this paragraph: In it's place, they put this: Section 10108: Free Choice Vouchers If a worker's health insurance contribution through their employer will be between 8%-9.8%, their employer has to offer them a voucher that will pay the employee's share if the worker would like to pick their own plan on the exchange. Section 10330: Update Computer Data Systems for Medicare and Medicaid Secretary of Health and Human Services must make a plan and determine the budget for modernizing the computer and data systems for Medicare and Medicaid Additional Provisions from The Health Care and Education Reconciliation Act Section 1103: Stops Medicare Advantage Excessive Profits Medicare Advantage plans must spend 85% of their revenue on medical costs rather than profit and overhead. Additional Information: Intro and Exit Music: Tired of Being Lied To by David Ippolito (found on Music Alley by mevio) Music: Begging for Change - Healthcare Blues by Peter Alexander Is Obamacare Enough? Without Single-Payer, Patchwork US Healthcare Leaves Millions Uninsured, Democracy Now, October 7, 2013. Treasury Department Memo (describes why the large employer reporting requirements are delayed for a year), July 2, 2013. Obamacare Medical Loss Ratio Saved $1.5 Billion in 2011, Insurance Journal, December 5, 2012.
Parents today are feeling that college is becoming less and less affordable. And if you’re one of those who are looking for ways to cut costs and still want to see their children through college, this edition is for you. We’ve turned the table in this podcast and you’ll be hearing questions from guest Jaynee Sasso and answers from Felicia …
Guest: Caleb Alexander, MD Out-of -pocket costs account for approximately one fifth of healthcare expenditures. Dr Caleb Alexander,an assistant professor of medicine at the University of Chicago, discusses with host Larry Kaskel, MD, the findings of his recent study that focused on patient-physician communications regarding out-of-pockets costs for outpatient treatment. An unfortunate finding is that doctors rarely communicate with patients about these costs, notwithstanding the fact that patients are quite burdened by these expenses. Tune in to hear Dr. Alexander discuss the key barriers to communications between physicians and patients and the recommendations for overcoming such hurdles. Interestingly, Dr. Alexander's research has found that giving patients free drug samples can often increase a patient's out-of-pockets costs, rather than reduce these expenses.
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