Entries for March 2009

With 401(k) accounts being a bit of a sore spot these days, this might not seem like a good time to consider a prescription drug program that takes its inspiration from a successful 401(k) participation strategy. But it turns out that in some ways, encouraging people to invest regularly in a 401(k) is not unlike encouraging people to stick to a regular medication regimen. In both cases, it's important to overcome the individual's tendency to procrastinate, either by not bothering to enroll in the employer's 401(k) on the one hand or by not getting around to signing up for an employer's prescription drug home-delivery program on the other.

Back in the mid-1990s, researchers discovered that one way to overcome people's natural tendency to put off signing up for a 401(k) was to enroll them automatically, deducting a certain amount from their paychecks on a regular basis unless they specifically asked their employer not to do so. That way, by doing what came naturally—putting off doing anything—employees ended up acting, or actually not acting, in their own best interests. Under automatic enrollment, participation in 401(k)'s jumped from around 35 percent to more than 80 percent, says David Laibson, an economics professor at Harvard University who has been studying these "opt out" programs for years.

In this era of 12-figure federal bailouts, a government proposal to spend a billion dollars on something seems pretty ho-hum. But the relatively paltry $1.1 billion that President Obama's budget would put toward comparative effectiveness research has created a firestorm of controversy, with conservative commentators and some providers raising the specter of regulation-happy government bureaucrats intruding into medical decisions that should be left to patients and their doctors.

It's hard to understand how reasonable people could oppose conducting the sort of research that aims to collect data so that we can actually know if one drug or medical device works better than another at fixing the same medical problem. This is good stuff, not only for the medical establishment but also for patients, who are increasingly expected to play an active role in managing and paying for their healthcare. And while I understand the concern that data could eventually be used to deny care if treatment is deemed not effective enough or too pricey, that hardly justifies not doing the research in the first place.

Getting people to stick to their prescribed medication regimens is tough, even in the best of times. But when someone loses a job or health insurance and money is tight, it's even more tempting to skip taking the pills that are critical to health and well-being.

The Kaiser Family Foundation's February health tracking poll found that more than half of people said they've cut back on necessary healthcare in the past year because of cost. Of those, 21 percent said they didn't fill a prescription they needed, and 15 percent said they split pills or skipped doses of medications.

Fertility treatments are an often expensive gamble but one that a growing number of would-be parents are willing to take. In their new book, Budgeting for Infertility, coauthors Evelina Weidman Sterling and Angie Best-Boss provide hopeful moms and dads with a manual for managing the one part of the fertility treatment process they can control: Paying for it. I spoke with Evelina Weidman Sterling, who has a Ph.D. in public health and has conceived two children with assisted reproductive technology, about the book.

What made you decide to do this book?
Infertility treatments can be exorbitantly expensive, and 70 percent of people pay for them completely out of pocket. In vitro fertilization can cost anywhere from $15,000 to $70,000 per attempt, and it can take several attempts. People can spend as much on family building as on a car or a house, and there are books out there on how to be a smart consumer in those areas. But not for fertility treatments. We wanted to tell people how to be a smart consumer and mitigate costs.

If you're worried about losing your job, deciding what to do about your health insurance coverage may be your most pressing benefits concern. But there's another health-related benefit that bears considering: your flexible spending account.

FSAs allow employees to contribute money to an account on a pretax basis to pay for healthcare expenses. These payroll deductions, which typically amount to a couple thousand dollars a year, cover out-of-pocket healthcare expenses like dental work, eyeglasses, insurance deductibles, and over-the-counter drugs.

"It takes a village," then first lady Hillary Clinton noted, to raise a child. Judging by the cast of thousands that attended President Obama's health reform summit today, the same might be said of nurturing national health reform (though now Secretary of State Clinton was conspicuously absent from this event, as she has been in general on healthcare reform since joining team Obama).

The purpose of the event was ostensibly to bring various stakeholders together to discuss ideas about how to reduce healthcare spending and improve health insurance coverage. And indeed, representatives of many interest groups were present, from insurers to private companies to patient advocacy groups, as well as dozens of elected officials. (Even the single-payer advocates got an invite to the summit, albeit a tardy one, I'm told.)

After I wrote about the new COBRA health insurance subsidy that was enacted as part of the economic stimulus package President Obama signed a few weeks ago, more than a hundred readers wrote in asking for specifics. Anxious readers who had lost their jobs wanted to know how they could apply for the subsidy, which will cover 65 percent of laid-off workers' COBRA health insurance premiums if they choose to continue their health insurance under their former employer's plan. The reason for their concern is no mystery: The federal law known as COBRA that permits them to extend their health insurance also requires them to pay 100 percent of the premium, plus an administrative fee of 2 percent. For people trying to get by on an unemployment insurance check of around $325 a week, shelling out $1,000 or more a month for health insurance is often not feasible. Even a helping hand of 65 percent doesn't make COBRA cheap, but for some the subsidy will at least make coverage affordable.

Unfortunately, passing the law is only the first step in the process. A significant amount of bureaucratic machinery must grind into gear before the federal government is ready to actually start paying for the subsidy. In fact, consumers may not get relief until May, says Cheryl Fish-Parcham, deputy director of health policy for Families USA, a consumer advocacy organization. If that happens, people who've paid their full premiums for March and/or April will be able to get either a refund for premiums paid since February 17, when the bill was signed, or a credit against future premiums.

Along with introducing his picks for top Department of Health and Human Services posts yesterday, President Obama announced something that may touch closer to home for many uninsured and underinsured Americans: $155 million to establish 126 new community health centers across the United States. (You can click here to go to the list of states that will receive more funding and links to existing community health centers in your area.)

Community health centers, which provide mostly primary care and preventive services to all comers at more than 7,000 locations, served 18 million people last year. As workers lose their jobs and employers pull back on coverage, those numbers are growing, according to the National Association of Community Health Centers. By law, no one is turned away from a community health center; patients are charged a sliding fee based on their ability to pay.