Lack of health insurance is not a problem that affects only poor people in this country. The
Census Bureau says that more employers are cutting health insurance. In households with incomes of more than $50,000
a year, the number of people without health insurance increased last year by 1.7 million to more than 12 million.
"This is a troubling trend," said Chris Jennings, the health policy coordinator for President Clinton,
in happy understatement.
But of course the biggest increase was among children under 6, to 23.6 percent nationally last year from 20.1 percent
in 1997. Ever been around a 3-year-old with a bad earache?
Despite a healthy US economy, nearly a third of low-income Americans still lack health insurance,
according to a new survey.
"In the midst of the best economy in 30 years, health care costs remain a significant financial burden for
many low- and middle-income families," concludes a statement from the philanthropic organization The Commonwealth
Fund.
In their survey, conducted by John Budetti of Princeton Survey Research Associates, over 5,000 Americans between
the ages of 18 and 64 were asked about income, access to healthcare insurance and options for employer-based health
coverage during the first half of 1999.
The survey results show that 19% of working-age adults lack health insurance. Of 'low-income' respondents
(median income below $35,000), 32% were uninsured and 41% of those earning $20,000 or less annually were uninsured.
Of those earning more than $35,000, only 7% were uninsured.
The Commonwealth Fund survey found that "many working Americans with below average incomes do not have the
option of obtaining coverage from their jobs, a problem that is particularly acute for low-wage workers."
The researchers found that Hispanics are at particularly high risk of being uninsured or for lacking access to
employer-based plans.
The survey also found that 24% of Americans failed to either see a physician, fill a prescription, or undergo a
recommended test or treatment because "they could not afford it."
This percentage works out at about 40 million people, the researchers say. Nearly half -- 45% -- of Americans who
ranked in the bottom fourth of the population in terms of income went without needed medical care in the previous
year, the Commonwealth Fund investigators say.
Those at the Commonwealth Fund predict that the problem will worsen. As a result, the group has created the Task
Force on the Future of Health Insurance for Working Americans. They describe the Task Force as a "nonpartisan
expert panel (that) will comprise individuals nationally recognized for their contributions in the fields of business,
government, public policy, economics and medicine."
The Commonwealth Fund (www.cmwf.org),
founded in 1918, is a philanthropy focusing on "improving health care services... and promoting healthy behavior."
Thomas Calls for End to Employer-based Health Insurance October 13, 1999
WASHINGTON, Oct 13 (Reuters Health) -- The employer-based healthcare
system in the United States is "fatally flawed" and needs to be replaced, a leading health policymaker
told the US Chamber of Commerce Wednesday.
"If you start with a fatally flawed concept, no matter how good the execution, you will never, ever succeed,"
House Ways and Means Health Subcommittee Chairman Bill Thomas (R-CA) told a forum on the uninsured.
By continuing to try to fix the current system by defining people in terms of their relationship to work, he said
"you're on a slippery slope to the government running not just health insurance, but the entire health system."
Thomas has been working for the last year on a proposal that would restructure the tax system so that individuals
would become responsible for purchasing their own insurance. "The only way out of this dilemma is to have
informed consumers," he said, "out in the healthcare marketplace with their own, after-tax dollars."
Thomas' plan, which is still being drafted, would include an "individual mandate" requiring everyone
to have a basic level of coverage, would limit the ability of insurers to 'cherry pick' by charging lower premiums
to healthier individuals, and would provide tax credits to those with high incomes and subsidies to those less
able to pay for their own insurance.
"I believe that to save the private healthcare system, you need to have universal coverage," he said.
In the meantime, however, Thomas for the first time said he was willing to support interim steps, such as limited
tax credits or deductions for those who currently get no tax
advantage for buying their own coverage. Such changes, he said, "are like putting money in bank accounts that
we would eventually cash in for the real solution -- health insurance for all Americans."
The National Breast and Cervical Cancer Early
Detection Program approved by Congress in 1990 was intended to be a tool in the fight against cancer. Unfortunately,
for too many poor women it has turned out to be a woefully incomplete tool.
The bill created a screening program that works - low-income women get mammograms and sometimes find that they
have cancer. When the diagnosis is bad news, however, far too many women find that they have no
funds for treatment and many others discover there is a distressing shortage of treatment facilities.
In essence, it says to women diagnosed with cancer through the screening program: "Thanks for coming in for
a mammogram or cervical exam. You have cancer but there is no guarantee of treatment."
The early detection program provides funding for all 50 states to conduct breast and cervical cancer screenings
for low-income women who do not have private health insurance and either earn too much or are too young to qualify
for Medicare.
I was one of the lucky ones. I had health insurance that covered my diagnosis and my treatment and, fortunately,
survived to become a member of one of the world's closest-knit and least exclusive sororities - the nearly 2.6
million American women living with breast cancer in the United States.
Many working poor woman are not nearly as fortunate. Once these women have been diagnosed with breast cancer, they
must depend on charity and donated care when it is available.
Some end up destitute or seriously ill simply because they ran out of resources on the road to a potential cure.
Others who do get care often find their treatment decisions are dependent on their financial resources. Physicians
who treat these women say that the women often make decisions based on what they can afford - rather than what
they need. For example, a patient may opt for a radical mastectomy rather than
breast-conserving surgery simply because she can't afford expensive radiation and chemotherapy treatments.
That's why the National Breast Cancer Coalition has made passage of the Breast and Cervical Cancer Treatment Act
a priority.
The legislation, sponsored by Reps. Rick Lazio, R-N.Y.; Anna Eshoo, D-Calif.; Ileana Ros-Lehtinen, R-Fla., and
Lois Capps, D-Calif., would guarantee treatment for women diagnosed with cancer through the screening
program. Passage of this bill will allow women whose poverty level makes them eligible for the CDC early detection
program to also be eligible for Medicaid treatment of breast or cervical cancer.
Under this legislation, states would not be required to participate, but states that do will receive an enhanced
match - 75 percent federal dollars and 25 percent state dollars.
NBCC members have witnessed the delay that can result from having to scramble to find the resources for treatment
- and the physical and emotional trauma that delay inflicts on women diagnosed with cancer. Our members also have
seen the resources of the screening programs being drained to help find treatment for patients. Here are a few
examples:
-- A woman in Florida had to wait five months before a volunteer found her treatment dollars. This woman livedfive agonizing months knowing she was sick and having no way to get the treatment she so desperately
needed. It's impossible to determine the precise impact the delay had on her disease progression, but it
certainly wasn't good.
-- A woman in Massachusetts already has spent her children's college fund for her treatment and is paying off more
than $20,000 in medical bills. During her treatment, her conversations with her doctors were more often about the
bills than their efforts to save her life.
--After her initial visit, a woman in California found she couldn't afford to continue the medication and radiation
recommended by her physician.
Other women whose mammograms indicated they need further diagnosis often don't seek it because they are, understandably,
afraid of finding out they have cancer, knowing full well they don't have money to pay for treatment. And some
women don't even go for screening, knowing that if cancer is diagnosed, there is no way for them to afford treatment.
What a horrible situation for anyone to face in a nation riding the crest of an economic boom that is unprecedented
in human history. As policy-makers debate how to spend our significant national surplus, many working poor women
in this country are relying on charity care, donated services by physicians or funds from bake sales and quilting
bees to treat their breast cancer.
Fran Visco is president of the National Breast Cancer Coalition, an advocacy
organization of 500 member organizations and more than 60,000 individual women, their families and friends. Readers
may write her at: NBCC, 1707 L Street NW, Suite 1060, Washington, DC 20036.
Immigrants in the 21st century will help save both Social Security and Medicare: Social Security
because their tax payments will help finance the retirement of the baby boomers, and Medicare because their willingness
to accept relatively low wages for difficult jobs -- picture all those orderlies in the nursing homes of the future
-- will mean decent care for the elderly without exploding costs. - Worth
Magazine, Sept '99
Las Cruces 'David' Takes On 'Goliath' Task Tiny Firm Invents Medical Bill Code by Meredith Rolley, for The Journal
September 13, 1999
LAS CRUCES -- A local firm's patented electronic billing system, which specializes in
claims for alternative medical treatments, is being considered for a national standard by federal health agencies.
Alternative Link Inc. of Las Cruces was granted its patent in June for its "Alternative Healthcare Provider
Billing" system. It covers claims processing, for the first time in detail and by specialty, for what is called
complementary and alternative medicine. Those treatments include acupuncture, chiropractic care, holistic care,
homeopathy, massage therapy, naturopathy and midwifery.
"The bottom line is that managed-care organizations and traditional insurers are lining up to begin covering
nontraditional medicine. To do that, they need a coding system," said Joe Gallagher, vice president of the
small firm.
The new billing system is a "crosswalk" that can link the detailed conventional health-care codes of
the American Medical Association with those covering untraditional medicine, he said.
The new system will allow health insurers:
* To easily incorporate complementary and alternative medical services into their benefits;
* Avoid liability by identifying which services are allowable under different laws in each state;
* Track the efficacy of those services and treatments as well as monitoring the performance of care providers.
The U.S. Department of Health and Human Services in November will choose a national standard for billing codes,
and Alternative Link's system is under review for acceptance. Once a standard is chosen, it will be used by the
Health Care Finance Administration, which administers the Medicare and Medicaid programs. The company was the only
one to testify before federal health officials and submit a system for complementary and alternative medicine.
The AMA, the Center for Communicable Disease and the American Dental Association have submitted
billing systems for conventional health care. Jo Melinna Giannini, a former Albuquerque resident and president
of Alternative Link, said she likes the David-vs.-Goliath chances for her billing system. One reason for her optimism,
she said, is that there are shortcomings in the present AMA codes, which basically handle alternative medical procedures
in a one-size-fits-all approach. Her company's process includes codes that define each procedure used by 13 complementary
and alternative medical
specialties and identifies the rule in each state governing delivery of that care, she said.
The actual processing of a medical claim costs about 20 percent of the total claim payment,
and an average claim has a 50-day turnaround time, she said. Alternative Link's system should help reduce costs
to about 5 percent of the total claim payment and complete processing in about three days.
Robert Mills, public information officer for the AMA in Chicago, said the organization would not discuss Alternative
Link's system. If the Las Cruces business' system is accepted, that should encourage more health insurers to expand
their alternative medical offerings or adopt them for the first time, Giannini said. "These codes not only level the playing field for
complementary and alternative medicine providers by letting them bill for services in a language that conforms
to current health plan practices, but it also paves the way for consumer access," Giannini said. The data
that will be gathered and provided by Alternative Link's process should encourage more insurers to cover alternative
medicine, said Brian Klepper, the president of health-care consulting firm Healthcare Performance in Jacksonville,
Fla. Caregivers can accurately describe their services for health plans, which solves a past problem in which complementary
and alternative medical treatments were coded on claims forms as "unlisted procedures," Klepper said.
In laymen's terms, Giannini explained how electronic billing works. "The insurance industry has gone electronic,"
Giannini said.
"To use a banking analogy, standardization of electronic messages makes it so everybody can use ATM cards
any place in the world, saving you time and money. "Insurance is going through the same standardization. Imagine
if every bank had an ATM card exclusive for its own transactions," she said. "At this time, among complementary
and alternative medicine payers and providers, there is no standard claims form." Alternative Link's system
provides just that.
"Remember that a claims form is more than just a way to approve or deny payment. It also collects data, what
we call outcome studies, including medical effectiveness, cost effectiveness, state-by-state legal compliance,
and much more," she said. "Outcome data allow insurance companies to predict the exposure," she
said. "This is comparable in existing software to conventional treatment patterns, which basically answer
the questions, 'What's the cost, what's the outcome?' ''
Giannini, who was born and raised in Albuquerque and attended Highland High School, began learning the medical
insurance trade working for the New England Financial Group in Albuquerque in 1987. She began working on her billing
system of nearly 4,000 codes three years ago. Since the patent was granted in June, Alternative Link's system has
been voted into the American National Standards Institute Implementation Guide For Electronic Standards and accepted
into the National Library of Medicine's Unified Medical Language System.
The system has the potential to generate as much revenue as the estimated $40 million a year now produced by the
AMA code system, Giannini said. The Las Cruces company also is in the process of getting the word out about its
product to health insurers and providers and plans to sell the product from business to business. The company's
official title for its system is "Method & System Encoding & Processing Alternative Healthcare Provider
Billing."
