Entries for April 2009

Iowa. Land of tall corn, early political caucuses and, it turns out, more affordable nursing homes than any other state. Genworth Financial, a big player in the long-term care insurance market, released its annual survey of nursing home, assisted living, and home-care costs today. It found that nursing home and assisted living costs continue to rise at more than double the rate of inflation, while home-care hourly rates are increasing much more slowly. In addition, this year the company developed a "choice and affordability index," that ranks states based on nursing home affordability and the number of homes compared with the size of the 65-and-over population. Based on those two measures, Iowa comes in No. 1.

Here are the top 10 states, in rank order:

1. Iowa
2. South Dakota
3. Kansas
4. Nebraska
5. North Dakota
6. Oklahoma
7. Missouri
8. Arkansas
9. Wyoming
10.Louisiana

The mirror doesn't lie, but it doesn't tell the whole truth either. No matter how you twist and turn, it's hard to see all your nooks and crannies, even if you want to (and many would rather forgo that treat, in any case). Still, to avoid skin cancer, you really do want a trained professional to do a yearly skin cancer screening—taking a careful squint at every inch of you, including your scalp and backside—to identify suspicious moles or growths.

Skin cancer is almost always curable if caught early, yet each year more than 10,000 people die of the disease. Melanoma, the most deadly form of skin cancer, is also the fastest growing. It afflicts 60,000 people annually and causes 8,000 deaths.

It has always been more challenging for workers at small firms to get affordable health insurance. Premiums are often higher and the coverage skimpier than at larger companies. But now a study highlights another area where workers laid off from companies with fewer than 20 workers get pinched: The 65 percent government COBRA subsidy to help people extend their health insurance is either not available to them or not as comprehensive in many states.

The COBRA subsidy, which was passed as part of the economic stimulus package in February, gives 65 percent of COBRA premiums, for nine months, to workers who are laid off between September 2008 and the end of this year. I've written about details of the subsidy before. But the subsidy applies only to workers laid off from companies with 20 or more workers; workers at smaller firms have to rely on state "mini COBRA" laws to determine whether the subsidy is available.

Times are tough. Everywhere you look, people are stressed out, anxious, depressed. But at a time when addressing some people's mental-health problems may be even more important than ministering to their physical aches and pains, two thirds of primary-care doctors say they have a tough time getting mental-health services for their patients. Doctors in a new Health Affairs study said several factors, from a shortage of professionals in some regions or in some specialties to problems with insurance coverage, make getting mental-health services challenging. (The study data came from 2004 and 2005, so chances are it's even more difficult now.) "It's a big problem," says Ted Epperly, president of the American Academy of Family Physicians, who says referrals are toughest in rural areas and the urban inner city.

There are no easy answers. Safety net organizations are feeling the pinch of increased demand and funding shortfalls. Meanwhile, if you've lost your job and your health insurance, you're most likely struggling with funding shortfalls of your own. But here are options that you (or even your doctor) may not be aware of:

One of the sticking points emerging in the health reform debate is whether to include a public insurance plan that could either be open to certain groups like the self-employed or perhaps be available to everyone. Now a new study by the Lewin Group spells out how much the premiums for such a plan might be and projects how many people might join.

The good news for consumers: The report estimates that premiums for a public plan would be up to 30 percent less than coverage under private insurance, or about $761 every month for a family, compared with a $970 monthly premium for the same coverage in the private insurance market. Single coverage would cost an estimated $298 a month under the public plan, versus $405 for private coverage. (The figures represent the total premium in each case, including both individual and employer contributions, if any.) Savings like that could be a serious boost for consumers who are struggling to afford health insurance.

Next year, seniors enrolled in Medicare Advantage plans may have to pony up an extra $40 to $70 a month in premiums or see services reduced by a comparable amount, according to estimates by the Blue Cross and Blue Shield Association based on new plan payment rates that the government announced yesterday.

"The most likely thing that plans will be forced to do is to change their benefit packages, increase benefit premiums, or increase cost sharing," says Kris Haltmeyer, the deputy executive director for legislative and regulatory policy for the association, which represents 39 independent Blues plans across the country. Collectively, the plans cover 1.5 million Medicare Advantage members. Altogether, roughly 10 million seniors are in Medicare Advantage plans.

As the automakers search for ways to cut costs, one of the areas that are likely to take a hit is retiree healthcare benefits. This was once a perk that many workers took for granted, along with their gold watches, but the number of employers offering retiree health benefits has been declining steadily for decades. Twenty years ago, 66 percent of companies provided retiree health benefits, according to the Kaiser Family Foundation. By 2007, that percentage had fallen by half.

Today, the only thing that's certain about retiree health benefits is that they're likely to change. If you have or anticipate getting health insurance through an employer when you retire, those benefits may be reduced or eliminated, if current trends continue. And the Medicare program itself may change. President Obama's budget proposed requiring wealthy seniors to pay more for drug coverage under Medicare Part D, for example, and there has been talk of allowing people as young as 55 to buy into the Medicare program.

Walgreens is a extending a helping hand to unemployed, uninsured workers and their families, offering to treat minor aches and pains for free at its Take Care clinics in 342 locations in some 30 metro areas. But there's a catch: To be eligible, workers or their family members have to have visited a Take Care clinic in the past. This is corporate do-goodism with an eye firmly on the bottom line. If you think you may be laid off anytime soon—and who doesn't, these days?—this is a none-too-subtle push to get you to visit a Take Care clinic for that tetanus booster or wart evaluation you've been putting off. Then, if a pink slip does arrive, you're good to go and can take advantage of the free care program. "There are still a lot of people who have no idea these clinics exist, and this will absolutely help raise awareness," says Darren Brandt, a spokesperson for Take Care Health Systems, the Walgreens-owned company that runs the clinics.