Udates on coverage and spending statistics can be found on the web pages of CMS and the Census Bureau.
This page has resources and notes on the following topics:
Web Resources and Notes on Private Insurance, Long-term Care, Uncompensated Care, and Health Care Fraud
The Georgetown Institute for Health Care Research and Policy has produced a very useful set of consumer guides that describe in each state all of the various state and federal provisions that affect the availability, pricing, and coverage of private health
insurance. These guides can be found at:
http://www.healthinsuranceinfo.net/. Although they are very user friendly and clearly written, the dominant impression one takes away from reading them is how incredibly complex the fragmented health insurance system is in the U.S. See also
University of Houston Health Law and Policy Institute, Choosing a Health Care Plan.. A good place to explore what type of information is available in choosing among health plans, and how a managed competition system might work, is the
web site for federal employees. To get a sense of what health insuarnce costs at different benefit levels, go to
EHealthInsurance.Com.
Here is a link to various federal statutes discussed in this section, such as the Health Insurance Portability and Accountability Act and COBRA.
The results of an in-depth study of various components of health insurance market reforms such as open enrollment and community rating can be found at: Wake Forest University Health Insurance Market Reform Study.
For discussion of various, more incremental or private-sector based reform proposals that are receiving current attention, see update for section F.1 of this chapter.
Consumer-Driven Health Care
For additional discussion of consumer-directed health plans
and increased patient cost-sharing, see updates to Chapter 1.C.3
Regarding consumer-driven ideas being applied even to Medicaid, see Sidney D. Watson, The View from the Bottom: Consumer-Directed Medicaid and Cost-Shifting to Patients, 51 St. L. Univ. L.
J. 403 (2007).
The Treasury Department has a useful website on Health Savings Accounts, at
http://www.treas.gov/offices/public-affairs/hsa/.
See also
John C. Goodman and Devon M. Herrick,
Health Savings Accounts: Answering the Critics (March 21, 2006).; Paul Fronstin and Sara R. Collins,
Early Experience With High-Deductible and Consumer-Driven Health Plans (Commonwealth Fund,
Dec. 2005); U.S. GAO,
First-Year Experience with High-Deductible Health Plans and Health Savings Accounts
(Jan. 2006); U.S. GAO,
Early Experience with a Consumer-Directed Health Plan (Nov. 2005).
Web Resources and Notes on Medicare and Medicaid
A good source for Medicare/Medicaid statutes and regulations is: http://hippo.findlaw.com/hippomed.html
Information about the current status of Medicare and Medicaid can be found on these two government web sites, www.cms.hhs.gov and www.Medicare.gov. See also Kaiser Family Foundation, Medicare at a Glance (June 2001); Eleanor Kinney, ed., Guide to Medicare Coverage Decision-Making and Appeals (2002); Terry Coleman, Medicare Law (AHLA, 2nd ed. 2006).
From Tom Mayo on the Health Law Professors blog: “Kaiser Family Foundation has a slick website to commemorate the 40th anniversary of the passage of Titles XVIII and XIX of the Social Security Act - the Medicare and Medicaid laws. What caught my eye were video documentaries on the political history of the two programs, from the 1930s to the mid-1960s. The documentaries (one on Medicare, one on Medicaid, one on both) are quite well done, partly because of some compelling excerpts of interviews with some of the principal players in 1965. Of course, Wilbur Mills and LBJ are long gone, but there are still some terrific interviews with the president of the AMA at that time, Edward Annis; Joe Califano, a White House staffer at the time; LBJ's chief of staff, Jim Jones, and others. Best of all, longer (7- to 9-minute) interviews with each of these fellows are available on the same page. I like the way these videos really make the federal health care programs come alive.”More detailed information on managed care under Medicare (known variously as "Medicare Advantage" or "Medicare+Choice" or Medicare Part C) can be found at:
www.cms.hhs.gov/medicarereform. See also Brian Biles, et al., Medicare Advantage: Deja vu All Over Again?,
W4 Health Affairs 586 (Dec. 15, 2004). Questioning the wisdom and practicality of using consumer choice principles to reform Medicare, see Yaniv Hanoch & Thomas Rice, Can Limiting Choice Increase Social Welfare? The Elderly and Health Insurance, 84 Milbank
Q. 37 (2006).
Excellent information about Medicaid, including a primer, program overview, and detailed fact sheets, can be found on the web site for the Kaiser Family Foundation, at these three links:
primer
program overview
fact sheet See also
Murphy's Unofficial Medicaid Page and the AHLA's question and answer
Guide to Medicaid Basics (or
here).
For detailed explanation of Medicaid eligibility for nursing home benefits, see www.ces.ncsu.edu/depts/fcs/frm/docs/fcs420.html
The government maintains a webpage for the
Medicare Moderization Act. For opposing viewpoints, see the materials compiled by
Community Catalyst. For additional discussion, see the detailed
summary by McDermott Will & Emery, the shorter summaries by the Kaiser Family Foundation
here and
here, and the extensive
Congressional Committee report and
diagram.
Capturing the maddening complexity of all of the Medicare prescription drug benefit is the following diagram, prepared by Yaniv Hanoch & Thomas Rice, Can Limiting Choice Increase Social Welfare? The Elderly and Health Insurance, 84 Milbank Q. 37 (2006).
The following is an example of how Medicaid estate planning can be used to pay for long term care for the middle class elderly. It was prepared by Wake Forest University law student Daren McDonough (class of 1999). Do you think this use of Medicaid funds is proper, or does this constitute abuse?
Example: Medicaid Estate Planning
Widow is a 70 year old woman who has recently been diagnosed with Alzheimer's disease. She owns a lovely home in suburban Charlotte, North Carolina. The home is completely paid off with a fair market value of $250,000. This does not include the value of the half acre garden which is adjacent to the property and which is used to produce vegetables which Widow consumes herself. She has one car, a 1991 Cadillac El Dorado. Widow has never worked, she was supported by her husband, Dirk, who was a pilot for U.S. Air. Dirk owned a restaurant as a tenant in common with two other individuals, and upon his death he transferred his interest in the business to Widow, along with $500,000 in the form of proceeds from a life insurance policy and other cash savings.
Widow has recently used her money to buy a new 1997 Lexus (after trading in her El Dorado), titled in only her name, a new bedroom setting, a new kitchen lay out, as well as three new pieces of jewelry. Upon learning that she has Alzheimer's, Widow contacted a local attorney, Will Mack, who advised Widow she had a number of options concerning her estate. At the time of her meeting with Mr. Mack, Widow received $800/month in social security and $300/month from Dirk's pension fund. Widow has four children, all over 22, one child has severe mental retardation and currently lives in an assisted living home. (This is paid for by a trust set up by Dirk, which has Mercantile Bank as the trustee, and upon the child's death the remainder is to be given to a stated charity.)
Widow is worried about losing her home. She currently has the home willed to one of her children. Widow has over $100,000 dollars invested in stocks and bonds and plans on giving these assets along with proceeds from her full life insurance policy to her three able bodied children at her death.
Mr. Mack informs Widow that there is a way she can keep her home, give away her other assets as she sees fit, and let Medicaid pay for her upcoming nursing home care. Mr. Mack informs Widow that in order to qualify for Medicaid assistance some assets may need to be transferred and some assets may need to change form or be liquidated and invested into other areas. Mr. Mack's proposal sets out:
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