Health-care costs are a serious problem, nine of 10 adults say

Nearly nine of 10 American adults say the cost of health care is a serious problem (chart) and about two-thirds of the general public believe that cost has gone up in the last five years.

These are the results of a poll released by the Robert Wood Johnson Foundation, the Harvard School of Public Health and National Public Radio.

The poll asked additional questions of Americans who said they have had a serious illness, medical condition, injury or disability in the past year. More than 40 percent said the cost of their medical care caused a "very serious" (20 percent) or "somewhat serious" (23 percent) problem for their or their family's finances.

"The rising cost of medical care affects everyone, but people who have been unwell know firsthand that an illness or injury can mean financial hardship or ruin," said Risa Lavizzo-Mourey, president and CEO of the RWJF. "These findings confirm how thinly individuals and families have been stretched. Having access to high-quality, affordable, comprehensive health coverage is crucial, but we know that even with insurance, rising health care costs leave many Americans with the burden of higher out-of-pocket spending." (Read more)

For first time, annual health costs for families exceed $20,000

For the first time, the average annual costs of workplace-provided health insurance and other costs for a family of four has exceeded $20,000, a new study has found. Costs are $20,728 this year, an increase of $1,335 over 2011.

An average family will pay $5,114 in premiums for a preferred provider organization plan, plus $3,470 in out-of-pocket costs like co-pays and prescriptions,  Jeffrey Young reports on The Huffington Post. The rest of the costs are paid by employers, according to the report released by Milliman, a firm that consults with companies on employee benefits.

"The rate of increase is not as high as in the past but total dollar increase was still a record," the report states. "The dollar amount of the increase overshadows any relief consumers might derive from the slowing percentage increase."

The report also found health-care costs vary among 14 metropolitan areas Milliman analyzed. Miami and New York City are most expensive where costs are 20 percent higher than the national average. Louisville and Lexington were not among the areas studied. (Read more)

Former head of Massachusetts health exchange says it's better to offer fewer, well-defined plans than set general criteria

With  Kentucky stakeholders discussing their options to set up a state-run health insurance exchange — something Gov. Steve Beshear said last week he intends to do if the Affordable Care Act is upheld by the U.S. Supreme Court — research shows the fewer plans offered in the exchange, the better.

An article in Health Affairs says officials should follow the lead Massachusetts' health-reform system when creating their own exchanges. "A hands-on exchange with the power to set standards on top of the federal health-care law will help prevent consumers from being 'overwhelmed' by the process of buying insurance," reports Sam Baker for The Hill's global affairs blog.

The Health Affairs article's lead author, Rosemarie Day, is a former deputy director of the Massachusetts exchange. She said consumers prefer choosing from "a handful of carefully vetted, clearly described health-care plans," Baker reports. The model used in Utah to allow any plan that meets criteria to be featured in the exchange is less popular, the paper found, but was more popular among conservatives.

"Findings from consumer research emphasized the value of limiting insurance plan choices on the exchange," the analysis states. "Specifically, early focus groups showed that consumers wanted four to six carrier options at 'low, medium and high' benefit levels." (Read more)

Tea Party protesters object to state-run health insurance exchange; leader says if there is one, feds should run it

By Tara Kaprowy
Kentucky Health News

A public meeting in Frankfort to get stakeholders' input about development of a state-operated health insurance exchange Monday was attended by dozens of Tea Party activists taking issue with Gov. Steve Beshear's intention to create it.

"It was absolutely a formal protest," said organizer David Adams, who writes the blog Kentucky Progress and managed Louisville businessman Phil Moffett's campaign for the Republican nomination for governor last year. "We are very, very strongly opposed and we're just getting started with our protest."

Last week, Beshear announced his intention to create a state-run exchange if the Affordable Care Act is upheld in the U.S. Supreme Court. Since 30 million Americans who don't have coverage now would be required to buy insurance under the law's mandate, the exchange would act as a marketplace in which individuals and employees of small business can choose from several plans that have coverage packages pre-approved by state and federal governments. The people buying from the exchange would be given subsidies to help pay their premiums.

States have the option to create their own exchange or have the federal government run one for them. Through February, Kentucky had received nearly $60 million to help set up an exchange, money officials said would be used for planning.

Several major business lobbies have said the state should have its own exchange, but Adams argues that if there is an exchange, the federal government should run it.

"This idea that if the state does it then we have some kind of control is like saying since we run Medicaid, we have control over Medicaid, which is absolutely not the case," he said. "If we have a state-run health insurance exchange, we will run it in the exact way that the federal government wants us to." He said he fears that once a state-run exchange is set up, "when federal funds run out, we'll be responsible for financing it."

"There is a place for helping people who absolutely can't help themselves," Adams acknowledged, but since people with an income of up to 133 percent of the federal poverty level qualify for the exchange, "We've changed the definition of who can't help themselves. We've moved that line way up into the middle class. In every part of life that we've done that, that has been very counter-productive."

Though the Supreme Court's decision about whether to uphold the mandate won't be known until June, Adams said he felt it was necessary to protest Monday's meeting "to demand that the government send back the $60 million and stop any activities of setting up an exchange." "I don't think anybody really believes that we need $60 million in federal grant money to set up a website to help people buy health insurance," he said. "We need to return that money and operate on a more fiscally feasible path."

In response to a question, Adams said the protest was not held to stir anti-Obama sentiment that might help Kentucky Republican candidates in the November elections. He said the insurance exchange is "just the tip of the spear" and that "the best thing we can do in managing our health care problems is stop going in the wrong direction."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Cabinet must 'wield the stick' to get managed care under control, state auditor says

Though the state has a solid contract "filled with all the mechanisms you need for enforcement, from the carrots to the sticks," the Cabinet for Health and Family Services has to be more aggressive in cracking down on the managed care organizations (MCOs) that run the state's $6 billion Medicaid system, state Auditor Adam Edelen says.

Edelen, who has been in office a little over four months, discussed managed care with Ryan Alessi, host of cn|2's "Pure Politics." Edelen is reviewing the new system and submitted 10 recommendations for improvement to the cabinet in February.

"The issues have been enormous — providers not being paid in a timely manner, a lack of communication between the cabinet and the MCOs and the providers, has created a system in which there is a lot of uncertainty and a lot of people are being squeezed out," Edelen said.

Couple that with the fact that Appalachian Regional Healthcare, which serves more than 25,000 Medicaid patients, sued two of the three MCOs in charge of the state, claiming they are owed $18 million for services that have been provided. Last week, ARH and MCO CoventryCares came to an agreement after being ordered by a federal judge to negotiate.

Edelen pointed out the broader ramifications of the situation. "If our largest Medicaid provider in the part of the state that needs it most for some reason is not able to operate within the system because they can't manage their relationship with Coventry or vice versa, that represents a structural threat to the system," he said. "We've got to figure out a way to make it work."

In order to do so, Edelen said "the cabinet has got to be willing to wield the stick" and is able to do under the terms of its contracts with the MCOs, which allow the cabinet to cancel contracts, "sanction and punish" the MCOs and make changes to the system. He said new cabinet Secretary Audrey Haynes has a tough job ahead and said "strong leadership" is critical.

When asked if his review looks into what work is being accomplished by the state's 200 employees who used to handle Medicaid — work that is now being managed by the MCOs — Edelen said it hasn't. (Read more)

Meanwhile, the Lexington Herald-Leader weighed in on the lawsuit between ARH and CoventryCares, saying in an April 24 editorial, "Coventry should keep working with Haynes and ARH on solutions. The editorial also stated, "Beshear, a former corporate lawyer, should bring the weight of the governor's office to bear and get busy making his Medicaid managed care contracts work." (Read more)

Beshear says he will create state health insurance exchange if federal health reform law is upheld

Gov. Steve Beshear said today that he will wait on creating a health insurance exchange under federal health reform until the U.S. Supreme Court rules on the constitutionality of the reform law, which is expected to happen in late June. He said in a press release, “The steps we have taken to date, and the planning process we are putting in place helps ensure the state is able and ready to follow the law.”

The exchange, a requirement of the Patient Protection and Affordable Care Act, would be a market for individual health-insurance policies. It would help small employers insure their employees in health plans and "enable individuals to receive premium tax credits and premium subsidies, and qualify small businesses for tax credits," the release said.

"The state has a $57.8 million federal grant to plan and implement of programs and systems required by the law, including "building an end-to-end eligibility and enrollment system to serve both Medicaid and exchange participants," the release said. "Kentucky previously received two federal health insurance exchange planning grants totaling $8.6 million." (Read more)

With time running short, why wait to issue an order? The court's decision "may impact the nature of the executive action," said Jill Midkiff, spokeswoman for the state Cabinet for Health and Family Services. "The timing of issuance of the executive order will not impact the current work or future work that is being completed to establish a state exchange. There is nothing that we need to accomplish at this point that requires an executive order to be in place."

Appalachian Regional Healthcare asks federal judge to make managed-care firm keep it under contract

Appalachian Regional Healthcare, a hospital chain in Eastern Kentucky and southern West Virginia, is seeking an emergency injunction by a federal judge ordering Coventry Cares to let its Kentucky members continue receiving services from the hospitals, and to avoid widespread layoffs the chain says will happen if the judge doesn't intervene, reports Bill Estep of the Lexington Herald-Leader. Coventry Cares is one of three state-approved companies to provide managed care services through Medicaid. It said it would cancel its ARH contract after Friday, which would affect about 25,000 Medicaid recipients.

With a few exceptions, Coventry members would lose access to treatment or have to travel long distances to get to other facilities approved by the company, which ARH and officials in affected counties say would be difficult for most because they don't have money or reliable transportation to make the trip. Coventry spokesman Matthew Eyles said the company would continue paying for some services at ARH hospitals, including ob-gyn services to women who are more than 12 weeks pregnant and have a relationship with an ARH doctor.

The state switched to managed-care last year as a way to save money, but as Estep reports, the move has been "rocky." Providers have complained about delayed payments from the companies and their cumbersome pre-approval processes for treatments. ARH sued Coventry and Kentucky Spirit, another provider, claiming the companies owed more than $18 million for services ARH had provided.  Estep notes, "The state allowed another managed care provider not to include ARH in its network, which meant a lot of higher-risk, higher-cost patients ended up covered by Coventry, the company said." The company also said the state failed to implement a method to assess risks that would adequately compensate managed-care providers who have more high-risk patients."

ARH and its Coventry patients think the company is trying to get more money out of the state. Many of ARH's patients are covered by Coventry, and ARH spokeswoman said about 300 to 400 jobs would be cut if Coventry cancels its contract. State officials are encouraging continues negotiation between ARH and Coventry. (Read more)

Meanwhile, Bardstown pediatrician and Passport Health Plan board member James Hendrick wrote a letter to the editor of The Courier-Journal offering Passport's services to "help the state get Medicaid back on track." He said he's been very impressed with the nonprofit's "strong and engaged provider network, and an intense focus on delivering services at a cost that doesn’t diminish quality," adding that because Passport is a nonprofit, it's not concerned with appeasing shareholders. Passport has been managing Medicaid in the Louisville region for several years.

What will high court do on health law? 4 most possible scenarios

Last week, U.S. Supreme Court justices heard arguments about the constitutionality of the federal health-care reform law. At the center of the debate is whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. There are four likely scenarios that will be the outcome of the justices' decisions, asserts Jennifer Haberkorn for Politico, all of which come with their own problems.

Scenario 1: The individual mandate is struck down, as well as insurance reforms: If these parts of the Affordable Care Act are scrapped, "Insurance companies will still be able to deny coverage based on customers' costly pre-existing conditions and charge more to older and sicker — or female patients," Haberkorn reports.

If that happens, the Obama administration and Democrats would likely blame Republicans for promoting a lawsuit that puts insurance companies in charge again. If reaction from the public is strong, Republicans may feel obligated to enact insurance reforms without an individual mandate. Ideas for doing this include "charging more if a person buys insurance at the last minute, tax incentives and a promise that if a person buys coverage, that person wouldn't lose it if he or she were to get sick and need it," Haberkorn reports.

Scenario 2: The mandate is struck down, but insurance reforms stay intact: Part of the reason why insurance companies agreed to stop denying coverage based on pre-existing conditions is they could offset the losses because the law would enlarge their insurance pool by 30 million people — the number of Americans who lack coverage.

If insurance companies are still required to stop denying coverage based on pre-existing conditions but the individual mandate is struck down "They could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn reports.

Scenario 3: The entire law, or the majority of it, is axed: That would mean unpopular parts of the law would be trashed, but so would popular ones, including the pre-existing conditions piece as well as a provision that allows young adults to stay on their parents' health insurance until the age of 26.

In 2010, 26 provisions took effect and another 17 did last year. Nine new provisions are taking place this year. "Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions began to take hold," report Michael Doyle and David Lightman for McClatchy Newspapers.

Scrapping the law entirely could cause the most political fallout. "Republicans would try to move quickly to enact a small-scale health reform legislation aimed at restoring some of the popular pieces of the health law," Haberkorn reports. "But Democrats won't want to support something far less comprehensive than the Affordable Care Act, not with some 50 million Americans uninsured."

Scenario 4: The law stands: Though this is the hope of the Obama administration, "The mandate is considered relatively weak: The penalty for not obeying it starts at $95 in 2014 — that's nothing compared with the cost of insurance premiums," Haberkorn reports. The amount increases to $695 by 2016.

As for what the justices will do, "at least some of the court's conservatives seem prepared to kill the whole bill," report Doyle and Lightman. "My approach would be, if you take the heart out of the statue, the statute is gone," Justice Antonin Scalia said.

Justice Elena Kagan countered, "Half a loaf is better than no loaf," while Justice Ruth Bader Ginsburg suggested, "It's a question between a wrecking operation and a salvage job."

Some justices said the whole bill should be sacked, "on the theory that members of Congress would not have voted for it without the mandate," Adam Liptak reports for The New York Times. But Justice Sonia Sotomayor said killing the whole law "would be too broad an assertion of judicial power," Liptak notes. Justice Anthony Kennedy, the likely swing vote, said "We would be exercising the judicial power, if one provision was stricken and the others remained, to impose a risk on insurance companies that Congress had never intended."

The justices probably decided the future of the law Friday morning, reports Mark Sherman for The Associated Press. Typically, an initial vote is "followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer," Sherman writes.

In Kentucky, health advocates and officials are watching closely to see what happens. "I think the entire health-care sector and insurance sector are watching this closely because it has significant implications on both industries," said Stephen Williams, chief executive officer of Norton Healthcare. "This is very far-reaching."

In Kentucky, the law extends coverage for 35,000 young adults, reports Laura Ungar for The Courier-Journal. (Read more)

Bill amendment could make dental, vision care more expensive

A last-minute amendment to a bill intended to limit when insurance companies could terminate policies may end up costing Kentuckians more out-of-pocket dental and vision expenses, Courier-Journal political writer Joseph Gerth writes in his weekly column.

The implications of House Bill 497 changed when Sen. Tom Buford, R-Nicholasville, "filed a one-paragraph amendment that was brought to him at the last minute by a lobbyist for the Kentucky Dental Association," Gerth writes. "That amendment said that if you have vision or vision insurance, your insurance provider can't require your health care provider to give you discounted rates on services that aren't paid for by the insurance plan."

That could mean that low-cost plans that only cover a few procedures but offer "added benefit by making sure you're not paying inflated prices for other services" may no longer be available, Gerth reports. Opponents say insurance companies will stop offering such plans because people won't buy them without the discounts. And people who can't afford more expensive plans will sacrifice dental and vision insurance.

On Tuesday, the Senate adopted the amendment and passed the bill. The bill cleared the House the next day. Gov. Steve Beshear has not indicated if he will sign or veto it.

Advocates say the bill will save in dental and vision care costs. Opponents say people will have difficulty having access to case. As for who's right, Gerth writes: "Bill advocates have presented no evidence to suggest that, and there have been no full-fledged hearings for the dentists behind the bill to make their case or to answer the questions that need to be asked." (Read more)

Will birth-control mandate cost more or less? Yet to be seen

Will requiring insurance companies to provide contraception be cost-neutral, as the Obama administration claims? It is unclear, and so is whether insurance companies will make Catholic institutions pay more. These were the findings of FactCheck.org, a nonpartisan, nonprofit, consumer-advocate project funded by the Annenberg Public Policy Center of the University of Pennsylvania.

In support of its claim, the administration cites data from Hawaii's birth-control mandate, which shows health insurance premiums "did not appear" to increase. The study also found the number of pregnancies increased after contraception coverage was required.

But when Pennsylvania considered imposing a similar mandate, a state agency found "the amount of possible savings relative to the cost of the legislation is unclear." Findings were also unclear in Connecticut when officials there looked at whether or not insurance plans saved enough because there were fewer pregnancies to offset the cost of providing coverage. A Texas study found insurance companies would not save enough because women would buy contraception on their own.

A recent survey of 15 insurance companies found six thought costs would increase and another three felt the move would be neutral in cost. None felt they would save money because of the mandate.

"Until better data are available, we're unable to conclude whether the Obama birth-control mandate is likely to result in a net cost increase or not," FactCheck reports.

Kentucky receives $57.9 million to set up insurance exchange

Kentucky received $57.9 million Wednesday to help set up a health insurance exchange or marketplace — though lawmakers have made no move to make that happen. Kentucky is one of 10 states to receive this latest round of federal insurance exchange establishment funds, which totals $230 million. Of these 10 states, Kentucky received the highest sum by several million.

Of the 10 latest states to receive grants, seven of them have adopted a plan or made substantial headway, reports Richardo Alonso-Zaldivar for The Associated Press. In the exchange, considered one of the cornerstones of the new health care law, individuals and employees of small businesses can choose from several plans whose benefits coverage packages have been pre-approved by the state and federal governments.

So far, 30 states and the District and Columbia have received grants. Of those, only 13 and the District of Columbia have adopted a plan for how to proceed. States have until Jan. 1, 2013.

"Kentucky has not determined whether it will establish a health benefit exchange in light of challenges to the Affordable Care Act and the lack of federal guidance and a tangible federal exchange model to consider," said Kerry Richardson, communications director for the Office of Gov. Steve Beshear, said at the end of January. "However, impending ACA deadlines require considerable planning, evaluation, design and development of systems to address exchange issues whether the state or the federal government operates the exchange, and we are engaged in those efforts."

In September 2010, the Kentucky Cabinet for Health and Family Services' Office of Health Policy received a $1 million exchange planning grant. In August, it received another $7.7 million to fund information technology systems. No bill has been introduced that would establish a state-based health insurance exchange so far. (Read more)

Health reform means millions more will be covered and more illness will be prevented, federal health official says at UK

By Tara Kaprowy
Kentucky Health News

What will the healthvcare system look like in 2020? Assistant Secretary of Health Dr. Howard Koh told a packed house in Lexington Monday that millions more people will have insurance, the patient will be at the center of a coordinated system, and there will be a great emphasis on prevention and public health "so the patient doesn't become the patient in the first place."

Koh talked about federal health-care reform during a panel discussion at the University of Kentucky's Albert B. Chandler Hospital. It also included Dr. Steve Hester, senior vice president of Norton Healthcare; Dr. Richard Lofgren, vice president of health care operations and chief clinical officer at UK HealthCare; and Stephen Wyatt, dean of UK's College of Public Health.

Koh said the current health-care system "is fragmented, it's episodic, it's not as coordinated as we would like, and there is still not enough attention to quality outcomes." But he said implementation of key parts of the health-care law would address those issues.

He said insurance is already more accessible, since companies can no longer refuse children with pre-existing conditions. By 2014, the same will be the case for adults. State insurance exchanges, which he called "a one-stop shop where buyers can compare plans," will inject "transparency in the whole market" and will ensure basic levels of coverage.

Insurance will also become more affordable, he said. The Medicare prescription "donut hole" is being covered; young adults can stay on their parents' plan until the age of 26; insurance companies must assure that 80 percent of their expenses go toward medical care and not overhead; and there will be a rate-review process, in which insurance companies wanting to increase their rates by 10 percent or more must formally defend their request.

Patient-centered medical homes will put the patient at the center of care and accountable care organizations, and "voluntary networks who have agreed to care for a defined Medicare population and also share in savings," will make coverage more coordinated, Koh said.

The law also puts systems in place for prevention and public health. On the individual level, new plans must cover "high-value preventive services and screenings," Koh said. Businesses are being encouraged to focus on wellness. The Centers for Disease Control and Prevention are offering community transformation grants so communities "can designs ways to make the healthy choice the easy choice," he said. And a national prevention counsel has been formed dedicated to public health.

The law also provides millions for health-care technology, which Hester said will revolutionize the health-care landscape and "the way we respond to patients." Koh agreed, saying a paper-based system "was another example of fragmentation. . . . prevSometimes you could find the chart, sometimes you couldn't. The electronic-based system will coordinate."

Hester said patients have recently become more equipped to accept the technology of electronic health records because they've become used to devices like smart phones. Logren said that, traditionally, patient records have been "proprietary." Electronic records will get information moving from place to place and will no longer be "owned."

Koh acknowledged one of the greatest challenges of the health-reform law is sustainability, but by 2020, he said "We will see stable funding and stable results" in public health and prevention. While the law has created divisiveness in the political arena, Koh said strong opinions about health care are a good thing because they generate discussion and passion. "We can debate many parts of the health reform law," he said, "but in the meantime, we are making progress."

Kentucky and most other states continue to delay action on health-insurance exchanges, despite Jan. 1, 2013 deadline

Though states must be able to prove whether or not they're ready to run a state insurance exchange by Jan. 1, 2013, many, including Kentucky, have not made any moves toward setting one up.

Kentucky officials have said they are waiting for more guidance to come from the federal level before anything can be decided, but there were indications that the administration of Gov. Steve Beshear might have been delaying action until last month's gubernatorial election. If Kentucky were to set up its own exchange, a move would likely have to be made in the 2012 General Assembly.

Jason Millman of Politico Pro writes an easy-to-understand summary of the complex issue and what it will mean for the American public: "Set to open in January 2014, exchanges will offer a marketplace where individuals and small businesses in each state can shop for health coverage. The exchanges, which offer subsidized coverage to lower- and middle-income individuals, will absorb more than half of the law's projected expansion of health coverage to 32 million people."

Some Republican-dominated states are waiting to see if the U.S. Supreme Court will rule the federal health-care reform law or its individual mandate unconstitutional, but a ruling is not expected until June at the earliest. "If that's when they start to work on an exchange, they will certainly be challenged to have a state-based exchange in 2014," said Steve Larsen, who oversees exchange development for the U.S. Department of Health and Human Services.

Wisconsin state Sen. Frank Larsee, chairman of the insurance committee, plans to wait even longer — opting to wait until after the 2012 presidential election. "Exchanges really aren't required until 2014, so we have plenty of time after November 2012," he said, not addressing the Jan. 2013 deadline.

So far, just 13 states have passed legislation to form an exchange. (Read more)

Smokers should pay more for health insurance, but obese should not, national poll finds

Nearly 60 percent of people in October's Thomson Reuters-NPR Health Poll said smokers should pay more for their health insurance than those who don't smoke, but 69 percent said "no" when asked if people who are overweight or obese should pay more.

Support for punishing smokers was greatest among groups less likely to smoke. Almost three-fourths of people in households with an annual income of $100,000 or more felt smokers should pay more than nonsmokers, Sarah Kliff of The Washington Post reports. There was nearly as much support — 70 percent — among people asked with at least a college degree.

But when it came to the weight-related question, the majority of people, regardless of education or household income, did not support having people who are overweight or obese pay more. Just 31 percent supported the idea.

Overwhelmingly, nearly 85 percent of respondents felt people who eat right and do not smoke should receive a discount on their health insurance premiums.

Each month, the poll surveys 3,000 Americans to gauge opinions on a variety of health-care topics. The poll, which is independently funded, has a margin of error of 1.8 percent. (Read more)

The poll results were released at a time when many mid- and large-scale companies are asking their smoking, obese employees to pay higher premiums than their more healthy colleagues. In 2012, almost 40 percent of these companies, including Walmart, will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009. (Read more)

Hike in health insurance premiums due to rising health costs, not reform law, FactCheck.org concludes

Health insurance premiums for employer-sponsored family plans shot up by 9 percent from 2010 to 2011, but the bulk of the hike is due to the increase in health care costs, not the federal health-care reform law, non-partisan FactCheck.org has found.

The law is responsible for about 1 to 3 percent of the increase, however, in large part because the law requires an increase in benefits, including: covering preventive care without co-pays or deductibles; allowing adult children to stay on parents' policies until age 26; increasing annual coverage limits; and covering children regardless of preexisting conditions.

"On the other hand, the fact that the law caused any increase at all casts more doubt on Obama's promise that the law 'could save families $2,500 in the comings years.' We've been calling that claim into question for several years now," Factcheck.org stares. "The plan fact is that — so far — the law has caused an increase in premiums, though not so large an increase as some Republicans claim." (Read more)

Haven't quit smoking, lost weight? Pay more for health insurance, more companies say

In an effort to keep health-care costs down, companies across the country, including Walmart, are opting to charge workers who smoke or are obese higher premiums than their more healthy colleagues. (Reuters photo by Lucas Jackson)

The move is the follow-up to a strategy many companies have already tried: to encourage workers to take better care of their health by offering benefits like weight-loss programs or smoking-cessation classes. But with few signs of the health-care landscape changing, "They're replacing the carrot with a stick and raising costs for workers who can't seem to lower their cholesterol or tackle obesity," reports Jillian Mincer of Reuters.

One example is Walmart, which in 2012 will start charging its smoking workers higher premiums. It will also offer cessation classes. A company spokesman said people who use tobacco use about 25 percent more health-care services than people who don't: "These decisions aren't easy, but we need to balance costs and provide quality coverage."

Critics say the move will limiting people's freedoms, create employee resentment and hut the lowest-paid workers hardest. "It's not inherently wrong to hold people responsible," said Lewis Maltby, president of the National Workrights Institute. "But it's a dangerous precedent."

Though well-intentioned, these policies can create bitterness. Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine, said having a colleague call to ask about a person's weight loss can be seen as intrusive. That's part of the reason why the janitors at the school participate, but "the professors on campus consider it a privacy tax, so we don't get some stranger calling us about how much we weigh."

Nevertheless, many companies are moving forward with the option. In 2012, almost 40 percent of large and mid-size companies will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009, an October survey by consulting firm Towers Watson and the National Business Group on Health shows. "Nothing else has worked to control health trends," said NBGH Vice President LuAnn Heinen. "A financial incentive reduces that procrastination."

Cleveland Clinic, with a staff of 40,000, has implemented a comprehensive program and seen its health-care costs grown just 2 percent this year. "The effort began several years ago when it banned smoking at the medical center and then refused to hire smokers," Mincer writes. "It later recognized that having a gym and weight -oss classes wasn't enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it." Paul Terpeluk, medical director of occupational health at the clinic, said employers have to develop a program and change the culture: "You don't do this overnight." (Read more)

Conway supports, P'Pool opposes meds-for-meth law; Conway defends decsion not to join lawsuits about federal health reform

In a debate where most of the sparks flew over often-specious questions about conflicts of interest, one of the biggest substantive disagreements between the candidates for attorney general Monday night was about whether to require a prescription for the cold medicine used to make methamphetamine. They also debated President Obama's health-care reform law.

Democratic Attorney General Jack Conway. left, said he supports such a law, which failed in this year's General Assembly, while Hopkins County Attorney Todd P'Pool, right, said he opposes it. The candidates were interviewed by Bill Goodman on KET's "Kentucky Tonight" as part of a series of debates between statewide candidates in the Nov. 8 election.

Republican P'Pool, the first to respond to Goodman's question, said he opposes making pseudoephedrine a scheduled drug because "I think it creates a burden for law-abiding citizens. . . . Let's don’t put a burden on soccer moms." He said he would support "a lifetime ban," which he did not explain, "for anyone convicted of a meth crime."

Conway said his position in favor of scheduling "is not the most politically popular position," but said he responded to a plea from "my friend Hal Rogers," the Republican congressman from Somerset who is a leading advocate. "I know it's not popular with some soccer moms," Conway said, and "I know it's inconvenient" to require a prescription, "but when you see a kid in a burn unit that’s gone through a meth lab it tears your heart." He said children at present at 80 percent of meth labs.

Conway said he is open to changing his position if opponents can show him how to prevent "smurfing," the use of surrogates to avoid the recordkeeping of pseudoephedrine purchases. He said many drug stories do not use the online recordkeeping system. He added that Oregon and Mississippi had "dramatic declines" in the number of meth labs after they scheduled pseudoephedrine.

P'Pool began the debate by sharply criticizing Conway's decision not to join lawsuits by Republican attorneys general challenging the constitutionality of the federal health-reform law: "He's absent form the fight against Obamacare … because he supports Barack Obama and his re-election." Conway replied, "I'm not gonna take some of the valuable resourecs of the office of the attorney general and put 'em on a lawsuit on health care when it’s an issue that’s gonna get decided anyway." He said some attorneys general are supporting the law in court, and "I didn’t join them either because I wanted to focus on Kentucky first."

As Goodman pressed the point, P'Pool said, "It’s really not about health care; it's about the proper role of the federal government." He said Kentucky could join the case with the stroke of a pen, but "My opponent has not been bashful in his support of Barack Obama and that’s why he’s on the sidelines."

Conway replied that the lawsuit "might undo some of the underpinning" of Social Security and Medicare laws. "This is not a perfect bill; some things need to be fixed in health-care reform," he said, but he implicitly defended the bill's requirement to buy health insurance: "It costs Americans on average $46 billion a year to cover the uninsured," he said. "They’re going to the emergency room to get their care … They’re already in the market. This is about being more efficient."

Click here for a story on the debate by Deborah Yetter of The Courier-Journal. Video of the debate is posted online here.

Health exchange could cost up to $34 million in Ohio; Kentucky still biding its time -- until after the election?

As 27 states, including Kentucky, bide their time in setting up a health care exchange — a key component of the federal health-reform law — Ohio officials have said setting one up in their state will cost $19 million to $34 million.

The undertaking could cost $8 million a year just for staff salaries, with 170 employees needed to run the exchange, reports Cliff Peale of the Cincinnati Enquirer. Marketing could cost $5 million a year, said a health-care consultant at Milliman Inc., an actuarial and consulting firm.

"Ideally, we want to see Obamacare repealed," said Susan Verble, deputy chief of staff for Ohio Lt. Gov. Mary Taylor, who also directs the Ohio Department of Insurance. "Whether it's a state or federal-run exchange, it's going to be costly for taxpayers."

Starting in January 2014, "the law will require all Americans to buy health insurance or pay a penalty and require companies with more than 50 workers to offer benefits or pay a penalty," Peale reports. Ohio and Kentucky have each received $1 million from the federal government to research how to start an exchange.

Kentucky has not decided whether it will operate an exchange. Officials with the Cabinet for Health and Family Services said last month Kentucky is still awaiting guidance from the federal government, but didn't respond directly when asked if the impending election for governor was also a factor. (Read more)

Tonight, acting Gov. Earl Ray Tomblin of West Virginia narrowly won a special election for the remainder of an unexpired term, after losing a big lead. The final television commercial from the Republican Governors Association was an attack that Kentucky Gov. Steve Beshear may be trying to avoid: A link between a Democratic governor and the unpopular Democratic president's health-care law, passed with only Democratic votes. --Al Cross, Institute for Rural Journalism and Community Issues

New survey shows dramatic increase in employer-sponsored health insurance rates

The average cost of employer-sponsored health insurance has increased 9 percent for family coverage and 8 percent for individual coverage since last year, a new study by the Kaiser Family Foundation and the Health Research & Education Trust shows. "Both increases are the largest since 2005," Tony Pugh of McClatchy Newspapers writes, surpassing the national 2 percent increase in wages and 3.2 percent increase in inflation.

Since 2001, family coverage premiums have escalated 113 percent while workers' wages have only risen 34 percent and inflation – 27 percent, Pugh reports. Researchers are unclear if the increase in premiums is temporary or whether higher increases will continue. "We really don't know, and we won't know until next year," Drew Altman, president and CEO of the Kaiser Family Foundation told Pugh.

Employers pay on average about 72 percent toward family coverage and 82 percent for single coverage, Pugh reports, leaving workers paying 28 percent for family and 18 percent for single coverage. Of those surveyed, about 31 percent of covered workers were in high-deductible plans, a 10 percent increase from 2006.

Increasing costs in medical care is "the main culprit behind the rate increases," Karen Ignagni, president of America's Health Insurance Plans told Pugh. "Insurers' expectation of stronger economic recovery" and insurers' fears of increased costs from the 2010 Affordable Care Act may be driving higher premiums, Pugh reports.

Despite insurers' fears, an analysis by Kaiser and the federal government suggest that the 2010 Affordable Care Act accounts for only 1 to 2 percentage points of the increase. Only two measures, coverage of adult children to age 26 and no patient cost-sharing coverage on certain preventive medical services, were implemented thus far with the remaining provisions taking effect in 2014, Pugh reports. This month, insurers will be required to publicly disclose information about rate increases of 10 percent or more for review by state or federal officials to determine if the increase is warranted. (Read more)

Lexington council turns to wellness center to cut insurance costs

Following a national trend to improve employee health so companies can cut health-insurance costs, the Lexington-Fayette Urban County Council agreed Tuesday to set up a wellness center for city employees.

The center will "be voluntary and free for employees, retirees and dependents covered by the city's health insurance plan," reports Beverly Fortune of the Lexington Herald-Leader. Acute and primary care, chronic-disease management and preventive screenings will be among the services provided at the center, the location of which has not yet been chosen. It is estimated to cost $1.3 million.

Chattanooga opened a similar center in 2006. Its health insurance costs were increasing about 20 percent annually, with health benefits costing the city $16 million that year. Today, the city is saving about $5 million a year, said Madeline Green, director of risk management and incentives for the city. (Read more)