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At least 19 recordsLinked to original sources
PubMed2005

Federal aid to state high-risk pools: promoting health insurance coverage or providing fiscal relief?

To help people whose health conditions make it difficult for them to obtain insurance coverage, the Trade Act of 2002 initiated federal matching payments to support state high-risk pools and promote coverage expansion through them. Some 30 states already had high-risk pools, but enrollment was very limited, largely because of high premiums, exclusion of coverage for preexisting conditions, and high cost-sharing. In interviewing officials from high-risk pools that received grants in the program's first year, the authors found that most states did not use grant funds to make their pools more accessible or affordable; instead, 18 of 19 states used some or all funds to refinance existing programs. Only one state used its entire grant award to reduce enrollee premiums, expand covered benefits, or otherwise enact changes to promote enrollment. Policymakers may need to strengthen grant requirements and/or financial incentives to promote expansion of coverage via state high-risk pools.

Consumer Behavior↗
PubMedDate not supplied

Expanding individual health insurance coverage: are high-risk pools the answer?

Thirty states operate high-risk pools intended to offer coverage to persons denied coverage in the individual health insurance market. But in most states the high-risk pool mirrors the individual market's problems: Coverage is expensive, the waiting period for coverage of preexisting conditions is long, and benefits may be limited. A few states with high-risk pools have addressed these problems by adequately funding high enrollment and comprehensive benefits; some also require the market to accept more risk. But most discourage enrollment in the high-risk pool in myriad ways and fall to ensure access to the individual market for persons with health problems.

Health Policy↗
PubMed1995

Health insurance problems among insured rheumatoid arthritis patients.

OBJECTIVE: To describe limitations in insurance coverage and their financial impact among a sample of rheumatoid arthritis (RA) patients. METHODS: A national sample of RA patients followed since 1988, completed a telephone interview about health insurance coverage, experiences with preexisting conditions clauses, and the financial impact of arthritis. Descriptive and multivariate logistic regression techniques were used to analyze the demographics and health status data. RESULTS: Trends in insurance coverage among people in this sample showed that participants were more likely to be in an HMO or PPO currently than 5 years previously. A majority of participants (67%) experienced financial impact from arthritis; 35% said that arthritis limited their ability to earn a living. Twenty-one percent had some insurance limitation because of arthritis as a preexisting condition. Eleven percent had been denied insurance. Those who had higher scores on the Stanford Health Assessment Questionnaire, were younger, were covered by Blue Cross/Blue Shield, and were more likely to be affected by a preexisting condition limitation. CONCLUSION: The data clearly indicate that even well-insured RA patients receiving care from rheumatologists experience limitations related to preexisting conditions and considerable financial impact.

Adult↗
PubMed1994

Implications of the Health Security Act for mental health services for children and adolescents.

Lack of adequate insurance coverage is one reason that the percentage of children who currently utilize mental health services is significantly lower than the estimated percentage of children with serious mental disorders. Principles of a reformed health care system with particular relevance for children's mental health services include coverage of a broad array of home- and community-based services, provision of organized systems of care for children with serious and persistent mental illness, mechanisms to ensure appropriate utilization of services, and provision of mental health services on the same terms and conditions as other health services. The Clinton Administration's proposed Health Security Act embodied many of these principles. In addition, its call for universal coverage and for elimination of insurance exclusions for preexisting conditions would extend mental health coverage to children who are currently uninsured or underinsured; the plan would also expand the range of services covered to include state-of-the-art approaches such as intensive nonresidential services and other alternatives to hospitalization. Implementation of the proposed plan would require developing the service and workforce capacity to provide a full continuum of services, ensuring availability of existing services, integrating existing and new systems of care, guarding against underserving children with serious mental illness, and planning for the role of Medicaid funding in the reformed health care system.

Adolescent↗
PubMed1992

Insurability of the adolescent and young adult with heart disease. Report from the Fifth Conference on Insurability, October 3-4, 1991, Columbus, Ohio.

By the mid-1990s there will be more than 500,000 young adults in the United States over the age of 21 with a cardiac malformation. Presently more than half of this population is denied insurance coverage entirely or in part because of their preexisting condition. Because some did not have coverage and because of uncertainty about whom to see for their cardiology care, patients assessed in NHS-II who were evaluated by their physician on an annual basis before the age of 21 were seen by a cardiologist only every 10 years after the age of 21. However, they have been shown by NHS-II to be well-educated, productive in the workplace, and to share an equal place in society with the general population. Their health-care costs are decidedly lower after the age of 21 than before. This group represents a microcosm of a general society of more than 37 million Americans who, for various reasons, are not insured. Dr. Wiener described an American health-care system in crisis. Smaller companies are no longer able to afford health insurance for all their employees, especially for those with preexisting conditions, because of an industry pricing concept based on a claims-experience standard rather than a community standard. The insurance industry, the government, and patients are demanding medical cost-containment. Health-care costs, 12.2% of the gross national product in 1990, are climbing, and no end to this increase is presently in sight.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Effects of the Health Insurance Portability and Accountability Act of 1996.

As small business employers, physician group practices will be subject to provisions of the Health Insurance Portability and Accountability Act of 1996 related to coverage guarantees. The act prevents currently insured individuals from losing coverage if they change jobs, limits insurance exclusions related to preexisting conditions, and requires insurers that offer small group coverage to make such policies available to all small employers. While the act's coverage guarantees may help group practices to attract good employees who formerly feared losing their coverage if they changed jobs, it also is likely to increase administrative costs, lead to premium increases, and limit to the choices for practices that must shop for health plans. Practices planning to purchase health insurance can ensure that they receive the best coverage possible by carefully comparing policy features and the claims services potential insurers provide.

Employee Incentive Plans↗
PubMed1997

Individual market health insurance reform: portability from group to individual coverage: federal rules for access in the individual market; state alternative mechanisms to federal rules--HHS. Interim final rule with comment period.

This interim final rule with comment period implements section 111 of the Health Insurance Portability and Accountability Act of 1996, which sets forth Federal requirements designed to improve access to the individual health insurance market. Certain "eligible individuals" who lose group health insurance coverage are assured availability of coverage in the individual market, on a guaranteed issues basis, without preexisting condition exclusions. In addition, all individual health insurance coverage must be guaranteed renewable. This rule also sets forth procedures that apply to States that choose to implement a mechanism under State law, as an alternative to the Federal requirements, with respect to guaranteed availability for eligible individuals. It also sets forth the rules that apply if a State does not substantially enforce the statutory requirements.

Career Mobility↗
PubMed1994

Health care reform based on an empowerment model of recovery by people with psychiatric disabilities.

People with psychiatric disabilities have articulated a model of recovery that encourages their empowerment by emphasizing consumer-defined goals, liberty, self-control of symptoms, peer support, elimination of discrimination, and provision of adequate material and social supports. Application of this model to health care reform requires public education to fight discrimination, an end to the use of involuntary interventions in the name of treatment, further development of services run by survivors-consumers and other alternatives to psychiatric hospitalization, and increased involvement of survivors-consumers in decisions related to their treatment and support. To promote empowerment of people with mental health problems, health care reform should include affordable, universal coverage without exclusions for preexisting high-risk conditions, parity of mental health benefits with other benefits, which includes coverage for voluntary services only, and incentives for funding long-term care, alternatives to hospitalization, and holistic healing services.

Health Care Reform↗
PubMed2005

HIPAA: past, present and future implications for nurses.

Congress enacted Health Insurance Portability and Accountability Act (HIPAA) in 1996 to limit the ability of an employer to deny health insurance coverage to employees with preexisting medical conditions. The law also directed the U.S. Department of Health and Human Services to develop privacy rules, including, but not limited to, the use of electronic medical records. This law has increased patient privacy, but in doing so has added to the financial burden, including personnel costs in health care. Nurses stand at the forefront in the resolution of the dilemma of patient privacy versus health care expediency. The purpose of this article is to assist nurses and other health care professionals to better understand their responsibilities regarding HIPAA regulations. First, responses to HIPAA regulations by covered entities to date, along with responses which are still needed, will be described. It will be noted that HIPAA is a work in progress and not a specific act. Next, future initiatives having HIPAA implications will be presented. In conclusion, the need for all covered entities and their personnel to look broadly at HIPAA as initiating a new way of work in health care will be emphasized.

Confidentiality↗
PubMed1996

Free flap coverage for knee salvage.

Soft-tissue reconstruction using free flaps was reviewed in 11 consecutive knee wounds complicated by joint exposure or adjacent osteomyelitis and unavailability of adequate local flaps. Ten free muscle flaps and one fasciocutaneous flap were used successfully. Eight limbs presented with wide exposure of the knee joint, including 4 patients with wound infection involving the joint. Three other patients suffered osteomyelitis immediately adjacent to the knee. All knees were successfully salvaged with a single free flap operation, except for one knee that required a second free flap after flap necrosis. Follow-up in nine flaps ranged from 7 weeks to 19 months (mean, 12 months). For patients without preexisting conditions affecting the knee, free flap coverage provided excellent return of knee function. The choice of recipient vessels was determined mainly by the region of the knee requiring coverage. The recipient arteries utilized included the distal superficial femoral artery, anterior tibial artery, popliteal artery, and small arteries, which included the saphenous artery and descending branch of the lateral circumflex femoral artery. The use of small arteries and venae comitantes as recipient vessels increased the effective reach of the free flaps and eliminated the need for vein grafts.

Adolescent↗