Wednesday, March 22, 2017

Do You Have Hypertension?

By Staci Brandenburg, RN

What are the signals and symptoms that I will have hypertension, a.k.a. high blood pressure? The answer may surprise you because most people do not have any symptoms! So, how do you know if you have hypertension? The truth is that the only way to know if you have high blood pressure is to have it checked! That is easy! You can run to your local drug store and check it on the free machine there.  Although the free machines may give you an idea of what your blood pressure is, blood pressure monitoring is not a "one-size fits everyone" deal. Your blood pressure needs to be checked by your doctor. What an individual may do to about about hypertension is attempt to prevent or control it!

High blood pressure is not always preventable. Factors like family, history, age, sex, and race are not controllable. What you can do to help prevent and/or control your high blood pressure is:

  • Eat plenty of fresh fruits and vegetables.
  • Eat foods low in sodium (salt). Read the labels on canned and boxed goods. Rinse your canned vegetables with water before cooking them.
  • Adults should exercise for a total of 2 hours and 30 minutes every week. Brisk walking is a good and inexpensive exercise. This will also help keep your weight in a normal range.
  • Quit smoking. Ask your doctor for help with this or in Indiana call 1-800-QUIT-NOW (1-800-784-8669).
  • Do not drink more than 2 drinks of alcohol for a man or 1 drink for woman.

(2017, March 03). Retrieved March 15, 2017.

Thursday, March 16, 2017

Key Benefits of the Affordable Care Act May Face Repeal As Well

By Beth Sullivan, CIN, CAC, SHIP Counselor and Scott Rollett, MBA, CMPE

Our country has a very complex health care system with multiple types of health insurance and multiple payers and forms for everything!  Trying to understand this complex system and how it works is almost impossible for the average person.  Therefore, when the Affordable Care Act (ACA) was signed into law in 2010 with its far-reaching effects, it is no wonder that many people didn’t fully understand all of the consumer-protection benefits or how the various components of the ACA were designed to work together to provide health coverage for as many Americans as possible.  As the Republican Congress and President Trump ready themselves to repeal the ACA, now is a good time to review some of the things that Americans will lose if their efforts are successful. 

Medical Loss Ratios (MLRs): 
MLR’s are the % of every healthcare premium dollar that consumers / employers pay the insurance company that are used for actual healthcare expenditures.  The ACA established that ratio must be at least 85%.  That means that 85% of premiums must go towards health care costs OR the consumer / employer gets a refund.  Prior to this rule going into effect, insurers could increase premiums however much they wanted each year.  Moreover, for health plans below a certain size, they weren’t even required to inform the consumer / employer of the MLR or to explain the reasoning for their annual premium increases.  Even for plans over a certain size, it was often difficult to get to the real number.  The ACA brought a level of transparency and accountability to Insurers that did not exist before 2010.  Below are two charts that represent the impact that the MLR rule had on the percent of healthcare dollars actually spent on the provision of health care services:   

The 85% Medical Loss Ratio guarantee is a key protection that Republicans hope to repeal with their pending AHCA bill. 

Essential Health Benefits: 
Another thing that the ACA did was establish minimum coverage standards that new (post-ACA) and non-grandfathered health plans must offer to insurees.  This was a very important step forward because many Americans did not have a good understanding of what their health plans did and did NOT cover.  Unfortunately, many found this out the hard way when they needed toaccess those benefits, only to understand that their plan either didn’t offer coverage or offered very limited coverage.  The Essential Health Benefit portion of the ACA made the following types of coverage mandatory for all new (post-ACA) plans and all non-grandfathered plans:

·      Pregnancy, maternity, & newborn care
·      Emergency Services
·      Hospitalization (Surgeries & Overnight Stays)
·      Outpatient Care / Ambulatory Care
·      Prescription Drug Coverage
·      Mental Health & Substance Abuse Services
·      Preventative & Wellness Services with 3rd Party cost-sharing (some at 100% coverage)
·      Pediatric Services including Oral & Vision Care

Critics of the ACA point to the creation of Essential Health Benefits as being one of the key reasons for the sharp increase in premiums in recent years.  They are partially right - - especially since this component of the ACA led to the elimination of cheap, catastrophic plans that offered limited coverage.  However, the increased focus on Preventative Care - - along with other key components of the ACA like Accountable Care Organizations - - was widely expected to “bend the cost curve” over time and there is abundant evidence that suggests that it was beginning to work. 

However, the elimination of this component of the ACA is a CORE piece of the AHCA bill.  Speaker of the House Paul Ryan calls this “Freedom of Choice” that will “…allow people to buy the health coverage they want”.  However, this is a misnomer of the first order as it does not give people a guarantee that they will have the health coverage that their family needs.

Elimination of Annual & Lifetime Coverage Limits: 
Prior to the ACA, many health plans had both annual coverage caps as well as lifetime coverage caps.  Essentially, this used to mean that once a member (or a member’s dependent) reached the annual or lifetime cap, there would be no more coverage for that member.  The annual coverage cap often varied greatly by the “richness” of the plan.  However, for many plans, $1,000,000 of lifetime coverage was very common prior to the ACA.  Once that cap was reached, the member would be forced to either find other coverage or pay out of pocket for their healthcare expenses until they became eligible for Medicare coverage.  Now it’s true that the vast majority of people will not utilize $1,000,000 in coverage prior to the age of 65.  However, there are many ordinary Americans that do.  Talk to the 50 year old man who received a diagnosis of aggressive prostate cancer.  Think of the 35 year old women who just got an ovarian cancer diagnosis.  Think of a young couple that was badly injured in a car accident and airlifted to a Level I Trama Center that saved their lives but left them needing expensive medical services for the rest of their lives.  Think of the premature baby born to 
loving parents that requires habilitative and rehabilitative care for most of their lives.  For these types of patients, they will quickly hit the lifetime cap.  Now this won’t happen to everyone, but it’d be a good guess to suggest everyone reading this knows someone who fits this description.  They’ll be guaranteed losers if the AHCA is passed.

No Denial of Coverage for Pre-Existing Conditions: 
Presently, the ACA prohibits insurers from denying coverage to anyone on the basis of their pre-existing conditions.  For many Americans, this protection was a godsend.  For cancer survivors, for diabetics, for anyone who had a serious illness and somehow lost their previous insurance coverage, they could no longer be denied coverage.  After the ACA was enacted, there were many testimonies that came out of cancer survivors who had lost their coverage because their battle with cancer prevented them from maintaining their coverage.  They won that battle only to discover that they had become uninsurable.  The ACA ended that nightmare for many people. 

Now the AHCA as proposed by Republicans claims to keep this protection intact.  However, there’s a catch.  The AHCA allows insurers to charge a 30% “penalty” on a new plan for anyone who lost their previous coverage.

Still Time to Act!
If Congressional Republicans and President Trump are successful in repealing the Affordable Care Act and replacing it with the awful AHCA bill, many Americans will lose out.  The non-partisan Congressional Budget Office (CBO) estimates that 14 Million Americans will lose their health care coverage in 2018 if the AHCA is signed into law.  Further, they project this number will rise to 24 Million by 2026.  That’s nearly 9% of Americans that presently have health care coverage!  However, because of the repeal of the above-mentioned ACA-protections, the damage that the AHCA will cause to American health care consumers goes well beyond 24 Million.  It will touch nearly every American in some form or fashion.        
But there is still time to act!  Consider carefully how the repeal of some of the ACA protections may affect you, your friends and family, or your neighbors.  Please consider letting your elected officials know what is important to you. 

If you live in the State of Indiana, below are your Congressional Representatives:

Senator Joe Donnelly (D)                                                                                Senator Todd Young (R)
720 Hart Senate Office Building                                                                     B33 Russell Senate Office 
Washington, D.C. 20510                                                                                 Washington, D.C. 20510
(202) 224-4814                                                                                                (202) 224-5623

District 1:                                                                                                          District 2:
Rep. Peter Visclosky (D)                                                                                  Rep. Jackie Walorski  (R)
2328 Rayburn House Office Building                                                              419 Cannon House Office Bldg
Washington, D.C. 20515                                                                                   Washington, D.C. 20515
(202) 225-2461                                                                                                  (202) 225-3915

District 3:                                                                                                          District 4:
Rep. Jim Banks  (R)                                                                                          Rep. Todd Rokita (R)
509 Cannon House Office Building                                                                  2439 Rayburn House Office 
Washington, D.C. 20515                                                                                   Washington, D.C. 20515
(202) 225-4436                                                                                                  (202) 225-5037

District 5:                                                                                                           District 6:
Rep. Susan Brooks (R)                                                                                      Rep. Luke Messer (R)
1030 Longworth House Office Bldg                                                                 1230 Longworth House Office 
Washington, D.C. 20515                                                                                   Washington, D.C. 20515
(202) 225-2276                                                                                                   (202) 225-3021

District 7:                                                                                                           District 8:
Rep. Andre Carson (D)                                                                                      Rep. Larry Bucshon (R)
2135 Rayburn House Office Bldg                                                                     1005 Longworth House Office 
Washington, D.C. 20515                                                                                   Washington, D.C. 20515
(202) 225-4011                                                                                                  (202) 225-4636

District 9:
Rep. Trey Hollingsworth (R)
1641 Longworth House Office Building
Washington, D.C. 20515
(202) 225-5315