Humana’s LifeSynch Offers Tips for Keeping New Year’s Weight Loss Resolution.

It’s that time of year. Gyms will be flooded with people ready to step on a treadmill. Grocery carts will be filled with fruits and vegetables instead of frozen pizza and chips. People will enter the New Year resolved to lose weight. But surveys show that most people don’t keep this resolution. Fortunately, there are some simple things you can do to change your lifestyle and drop the pounds, according to Dr. Ken Hopper of LifeSynch, the behavioral health and wellness subsidiary of Humana (NYSE: HUM) .

Hopper offers the following simple tips toward achieving your New Year’s weight loss resolution.

1. Slow down! Sit down at a table and really think about what you are
eating. Try eating with your non-dominant hand or using smaller
utensils. Doing this will help you savor and not scarf your food. You
will also realize that you are full before you eat too much.

2. Stop. Don’t eat while you are distracted. This means putting down the
remote, putting your car in park or putting away the cell phone. Eating
involves more than just putting food in your mouth. We use all five
senses while we eat. We smell, see, taste, hear and touch. Pay
attention to all of them.

3. If it’s not there, you won’t eat it. Don’t buy unhealthy foods that
will tempt you every time you open the pantry. It is easier to resist
buying tempting foods for 30 minutes at the store than to resist eating
them for 24 hours a day if they’re in your house.

4. Be selective. If you can take or leave doughnuts, why take one just
because it’s offered? Ask yourself if you would really enjoy it. If you
wouldn’t, hold out until you have a chance to eat your very favorite
treat.

5. Find substitutions. Crave chocolate? Try a cup of low sugar hot
chocolate or a pudding cup. Plain yogurt can replace mayonnaise or sour cream. Applesauce can replace oil in most baking recipes.

6. Snack with purpose. Try a combination of protein and carbohydrates. Examples are string cheese and a handful of nuts, an apple with peanut butter, or yogurt and berries.

7. Get support. You don’t have to do it alone. Many organizations offer
wellness benefits through companies like LifeSynch. Some include health
coaches that provide motivation and can help you find ways to reach
goals. Also recruit your family and friends to make some of the same
changes.

The easiest way to make healthy changes is doing things that are realistic and sustainable for your life. If you cannot see yourself doing something two months from now, then don’t go for it. Change your mindset. Don’t say, “I will do it tomorrow.” Say, “I will do it today.”

About LifeSynch:

LifeSynch, a subsidiary of Humana, is a national health and productivity solutions company. LifeSynch’s mission is to identify, develop and apply innovative behavioral-focused solutions that optimize health and productivity. LifeSynch provides total behavior solutions to more than 4 million members. For more information, visit http://www.lifesynch.com/.

About Humana:

Humana Inc., headquartered in Louisville, Ky., is one of the nation’s largest publicly traded health and supplemental benefits companies, with approximately 10.3 million medical members and approximately 7.3 million specialty-benefit members. Humana is a full-service benefits solutions company, offering a wide array of health and supplemental benefit plans for employer groups, government programs and individuals.

Source: Humana

CIGNA’S CoachRx … A Prescription for Better Health.

As former Surgeon General C. Everett Koop, M.D. once said, “Drugs don’t work in patients who don’t take them.” That’s why CIGNA is introducing CoachRx, an interactive Web site to help CIGNA Home Delivery Pharmacy customers identify their personal barriers to taking their medications, and then providing ways to help people stay on track with the medications they need.

After taking a self-assessment to help individuals determine their own barriers to taking their medications, customers can then sign up for daily reminders through a variety of ways, including cell phone text messages, voicemails or emails. They can also sign up for reminders to take vital signs such as blood pressure or blood sugar levels, or to remember to schedule, or go to, medical appointments.

“We want to reach individuals with information in a way that will do the most good,” said Yi Zheng, PharmD, assistant vice president of pharmacy clinical programs for CIGNA. “People’s schedules today are already hectic, which is why we’re trying to help in ways that work best for them.”

For those who may need additional assistance, there’s a toll-free number to call for medication coaching sessions with a clinical pharmacist, who works with health coaches and nurse case managers to help the individual establish health goals. Coaching help includes:

  • identifying issues such as medication side effects or what can be expected from a particular medication, including working with the physician to see if another medication might be better;
  • reinforcing the importance of not skipping doses or taking only half the medication prescribed;
  • helping to understand why it’s important to take needed medications even when someone is not feeling sick;
  • explaining information on the medication bottle or benefit coverage; and
  • providing information on ways to lower medication costs.

Free pill boxes to help organize medications, educational materials to understand medical conditions, discount coupons to help offset costs, and reminders when it’s time to refill a prescription are included in the program.

“Once people leave the doctor’s office, physicians have limited ways of knowing if their patients fill a prescription or take their medications correctly,” said Zheng. “There are many reasons why individuals may not take their medications. People often don’t like the side-effects, don’t understand why they have to take a medication, or simply forget — which can hurt their health.”

Zheng points out that medication adherence is a complex and costly issue. According to a report by the New England Healthcare Institute, non-adherence leads to poorer health, more frequent hospitalizations, a higher risk of death and as much as $290 billion annually in increased medical costs.

“We know that staying on track with medications is not always easy,” said Zheng. “That’s when we’re here to help.”

About CIGNA:

CIGNA (NYSE:CI), a global health service company, is dedicated to helping people improve their health, well-being and sense of security. CIGNA Corporation’s operating subsidiaries provide an integrated suite of medical, dental, behavioral health, pharmacy and vision care benefits, as well as group life, accident and disability insurance, to more than 46 million people throughout the United States and around the world. To learn more about CIGNA, visit www.cigna.com.

Is It Really Double Counting?

Last week, we picked up on a letter that was sent to Congress by the Congressional Budget Office (CBO) that said CBO had double counted the savings that would result from the cuts to Medicare included in the Patient Protection and Affordable Care Act (PPACA). Read post.

Essentially, the CBO said that it had credited the savings to the Health Insurance Trust Fund (HI) extending the amount of benefits that can be paid out. While at the same time, the cuts were also being used to offset the additional costs of providing subsidies to low income uninsureds to all them to buy coverage.

In the words of the CBO:

“To describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government’s fiscal position.”

The New York Times tackled this issue yesterday in an article by Robert Pear that attempts to explain how technically it might be possible for the Senate bill to be able to reduce the deficit by $132 billion in the next 10 years while adding nine years to the life of Medicare’s hospital trust fund.

No disrespect to Mr. Pear, but even after reading his explanation of how this may not be double counting, I have to agree with Sen. Jon Kyl of Arizona, the No. 2 Republican in the Senate, when he summarized the situation by saying. “You can’t sell the same pony twice.”

Why the Big Emotional Reaction to the Senate Health Bill?

John Goodman’s Health Policy Blog is a good read today, as the “Father of Health Savings Accounts” asks, “What is causing the huge emotional reaction both on the right and the left? To the health bill the Senate passed on Christmas Eve, that is.”

Goodman points out that bill would not solve any of the problems that its proponents talked about.  He writes that the bill will not lower health care costs. It will not improve quality of care and probably would not improve the average access to care. But it would do two very important things almost no one has talked about.

  1. For the first time in U.S. history, we are about to nationalize the health insurance industry; and
  2. Going forward, no one will ever be able to pay a real price for health insurance again.

At the heart of this is the fact that health insurance plans will be unable to innovate.

“Gone forever will be the ability of insurance companies to creatively and innovatively solve the core problems of cost, quality and access,” writes Goodman. “Insurers will not be able to innovate in these ways because it will be illegal to charge patients or their employers a premium that reflects the value the innovation creates for the patients.”

In the long run, problems are not only not going to be solved. They almost certainly are going to get worse.

Read John Goodman’s entire blog post here:

CDPHP Goes Live with Suite of TriZetto Applications to Enhance Administrative Efficiency and Quality of Care.7

The TriZetto Group, Inc. today announced that CDPHP®, a not-for-profit, physician-guided health insurer, went live in July with TriZetto applications that will help New York’s top-rated health plan* continue to reduce costs and improve quality as part of its company-wide “health value strategy.”

!Trizetto-logoThe enterprise, network management and Web-based applications, which augment CDPHP’s use of TriZetto’s core administrative system, enhance the efficiency with which CDPHP administers claims, provider contracts and transactions and the exchange of information between the payer organization and its valued constituents.

“TriZetto’s highly integrated information systems permit access to a considerable amount of additional data, enabling us to further enhance population management, conduct predictive modeling and help members by anticipating health issues,” said Barbara Downs, senior vice president and chief operating officer, CDPHP. “TriZetto’s applications provide the flexibility and scalability to help further improve our administrative efficiency, and more importantly, the quality of care for our members.”

“The combination of TriZetto systems will make it even easier for CDPHP providers, employer groups and members to tap into the health plan’s benefit system to obtain the information they seek in the right format,” said Tony Bellomo, president of TriZetto. “TriZetto’s integrated set of solutions powers Integrated Healthcare Management, the systematic application of processes, shared information and aligned incentives to optimize the coordination of benefits and care for the healthcare consumer. With our core administration, network management and constituent Web applications in place, CDPHP is solidifying its market leadership by moving aggressively toward its health value strategy.”

The simultaneous go-live of multiple applications capped another successful implementation by TriZetto characterized by open, ongoing communication with the payer customer throughout the process.

“Our implementation experience with the TriZetto team was a true partnership,” Downs added. “Their innovation and commitment to excellence created the trust that was essential to the success of the effort. The CDPHP and TriZetto implementation project can serve as a model for the future.”

About CDPHP:

Celebrating its 25th anniversary in 2009 as a physician-founded and guided health plan, CDPHP® and its affiliates currently serve members in 29 counties throughout New York State and seven counties in Vermont. The affiliated companies of CDPHP include a family of products: Capital District Physicians’ Health Plan, Inc. — HMO, Healthy New York, Medicare Choices (HMO), Medicaid, Child Health Plus and Family Health Plus; CDPHP Universal Benefits,® Inc. — PPO, High Deductible PPO, EPO and Medicare Choices (PPO); and Capital District Physicians’ Healthcare Network, Inc. — self-insured plans. Visit CDPHP at www.cdphp.com/.

About TriZetto:

Founded in 1997, TriZetto is the leading privately held healthcare information technology company to the healthcare payer industry. With its technology touching half of the U.S. insured population, TriZetto is Powering Integrated Healthcare Management™, the systematic application of processes and shared information to optimize the coordination of benefits and care for the healthcare consumer. The company’s offerings include enterprise and component software, hosting, outsourcing services and consulting that help payers implement and optimize their operations and minimize the risk of bringing to market new products that drive competitive differentiation.

*Ranking for commercial plans by U.S. News & World Report/NCQA America’s Best Health Insurance Plans 2009-10. “America’s Best Health Insurance Plans” is a trademark of U.S. News & World Report.

Source: Trizetto

BCBSNC Rewarding Physicians for Better Care, Not More Care, Through Blue Quality Physician Program.

Blue Cross and Blue Shield of North Carolina (BCBSNC) is leading an effort to reward health care quality in North Carolina by introducing a new reimbursement model for participating primary care physicians.

BCBSNC, the state’s largest health insurer, is offering substantially higher payments to physicians who take steps to further improve the quality of patient care they provide. Under its Blue Quality Physician Program, about 4,000 primary care physicians across the state have been invited to apply for the higher reimbursement structure. The program is designed to reward quality over quantity in the delivery of medical services.

“For too long our health care system has been built on paying for the volume of procedures rather than the quality of outcomes,” said Don Bradley, M.D., BCBSNC senior vice president and chief medical officer. “Blue Quality Physician Program is our way of getting incentives where they belong – with quality outcomes, not volume.”

The program is open to North Carolina primary care physicians – family and general practitioners, internists, pediatricians, obstetricians and gynecologists – who agree to BCBSNC’s standard contract for in-network physicians.

Participating physicians who meet a set of criteria that includes nationally recognized, evidence-based standards for quality of care are eligible for reimbursement that offers double-digit increases over BCBSNC’s standard fee schedule for some of their most commonly billed codes. BCBSNC will reimburse at a higher level once the physician is approved for the program.

“Physicians understand the need to measure quality and improve efficiency, but often don’t have the resources to upgrade their office infrastructure and evaluate results,” said Joseph Ponzi, M.D., with Goldsboro Pediatrics, a practice with multiple offices in Eastern North Carolina. “Programs like these are a great incentive to investing in improving patient care, developing the ‘medical home’ concept and meeting higher quality standards, while becoming eligible for higher reimbursement.”

BCBSNC introduces Blue Quality Physician Program on the heels of its successful Bridges to Excellence quality improvement program. That three-year pilot program, which concluded in April 2009, brought the nationally recognized Bridges to Excellence program to North Carolina, offering incentive payments to physicians meeting national standards.

Following the Bridges to Excellence pilot, BCBSNC determined that providing incentives for meeting quality standards had a payoff in terms of higher quality measures and lower health care spending per patient. For example, patients of physicians who met Bridges to Excellence quality standards for efficiencies in practice management received fewer high-cost imaging tests such as CT scans and didn’t visit the emergency department as often.

“Health care is embracing quality and efficiency standards, which also offer promise for improving the affordability of health care,” said Milo Brunick, BCBSNC vice president of Network Management. “Blue Cross and Blue Shield of North Carolina looks forward to collaborating even more with physicians, hospitals and other health care providers to improve cost and quality for patients.”

Participating physicians in Blue Quality Physician Program earn higher reimbursement by achieving standards in three categories:

  • Clinical quality outcomes, which includes recognitions by the National Committee for Quality Assurance, use of electronic prescribing and other quality-related standards
  • Administrative efficiency, including electronic claims submission
  • Patient experience with care, which measures the physician’s ability to provide such patient-centered needs as after-hours care and electronic visits

BCBSNC will review physicians’ applications and assign scores based on the number of quality criteria met. Any physicians not meeting minimum scores may re-apply.

About BCBSNC:

Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more than 3.7 million members, including approximately 900,000 served on behalf of other Blue Plans. For 76 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at www.bcbsnc.com.

Various Parties React to Passage of Heath Care Bill.

The following are excerpts from statements issued today by various trade groups and individuals regarding the Senate’s passage of the Patient Protection and Affordable Care Act.

AMA: Senate Bill Passage Historic, More Work to Do in Conference

The following statement is attributable to J. James Rohack, M.D., President, American Medical Association:

“Today, the Senate took an historic vote to improve our nation’s health care system by expanding coverage to millions of Americans and strengthening the private insurance market to better serve the patients who rely on it. The AMA supported passage of the bill because it contains a number of key improvements for our health care system, which currently is not working for far too many patients or the physicians who dedicate their lives to patient care.

“Separate action is needed early next year to permanently repeal the current Medicare physician payment formula to preserve access to care for America’s seniors, baby boomers and military families by creating a stable physician payment system. We commend Senators Reid and Baucus for keeping the focus on a permanent solution to this problem, and we will continue to work closely with them to fix the flawed Medicare physician payment formula once and for all early in the new year.”

AARP Thanks Senate for Passing Health Care Reform

AARP CEO A. Barry Rand released this statement after this morning’s passage of the Patient Protection and Affordable Care Act.

“The bill passed by the Senate makes needed progress to prevent coverage denials due to health status and limit insurance companies from charging older Americans much more for coverage because of their age. It also begins to close the dangerous gap in Medicare drug coverage known as the doughnut hole, and Senate leaders have committed that a final bill will close the gap entirely by 2019, in keeping with the President’s pledge. In addition, the Senate bill adds important new Medicare benefits, like free preventive care, and encourages states to provide more home and community-based long-term care services and supports instead of costlier institutional care.

“AARP thanks the Senate for advancing this critical legislation. We look forward to working with members of both chambers during the conference committee to improve this legislation and enact a final package that is even stronger so that America’s health care system finally meets the needs of our members and all older Americans.”

AHIP Statement on Passage of Senate Health Care Reform Legislation

Karen Ignagni, President and CEO of America’s Health Insurance Plans (AHIP), released the following statement today on passage of Senate health care reform legislation:

“Providing all Americans with health care coverage is crucial for the country. Health plans support legislative changes that would provide guaranteed access to all Americans, with no pre-existing condition limitations and no health-status-based premiums. These reforms are essential to giving all Americans greater peace of mind and health security.

“At the same time, specific provisions in this legislation will increase, rather than decrease, health care costs; reduce coverage options; and disrupt existing coverage for families, seniors and small businesses – particularly between now and when the legislation is fully implemented in 2014.

FRC Statement on the Christmas Eve Passage of the Health Care ‘Reform’ Bill

Family Research Council President Tony Perkins made the following comments:

“Today’s Christmas Eve vote may signal the end of the debate in the Senate, but it’s far from the end of the debate at large. Since Senator Reid’s bad bill is substantially different from the House’s bad bill, the lower chamber will have to vote on the plan again. The Senate bill’s massive funding for elective abortions and the construction of abortion facilities are among the most radical differences. On Monday, Health and Human Services Secretary Kathleen Sebelius admitted in an interview that the Senate health care bill will force ‘everybody’ in the exchange to pay an abortion premium. The so-called Nelson ‘compromise’ ensures that everyone will pay for abortion–no matter how the funds are divided up.

Pelosi Statement on Senate Passage of Health Insurance Reform Bill

Speaker Nancy Pelosi issued the following statement this morning on the Senate voting 60 to 39 to pass historic health insurance reform legislation:

“Today’s vote in the United States Senate brings us closer to providing quality, affordable health insurance to every American. I commend Senator Reid for his strong leadership in passing this bill, which takes a critical step on behalf of the health and security of all Americans.

“We are proud of the House bill, which provides more affordable coverage for the middle class, covers 36 million currently uninsured Americans, begins health insurance reform in 2013, fully closes the prescription drug donut hole for seniors, mandates strong reforms of the insurance industry, and is fiscally responsible, cutting the deficit by $138 billion over 10 years.

“As we move forward through the legislative process, we will soon produce a final bill that is founded on the core principles of health insurance reform: affordability for the middle class, security for our seniors, responsibility to our children by reducing the deficit, and accountability for the insurance industry.

PhRMA Statement on Senate Health Care Reform Bill

Pharmaceutical Research and Manufacturers of America (PhRMA) Senior Vice President Ken Johnson released the following statement about the Senate health care reform bill:

“We applaud the Senate for taking an important and historic step toward expanding high-quality, affordable health care coverage and services to tens of millions of Americans, many of whom are struggling today financially. While considerable work remains to be done in reconciling differences between the Senate and House bills, we remain convinced that comprehensive health care reform, if done in a smart way, will benefit patients, our economy and the future of our nation.

“Most importantly, the Senate bill recognizes the importance of medical progress in America. Innovative, cutting-edge medicines have dramatically increased life expectancy rates in the United States and have allowed patients with cancer, heart disease, diabetes and other devastating chronic diseases to live longer, healthier and more productive lives. We strongly believe that everyone in America should benefit from promising new advances in medical care.

Statement of Americans United for Life Action President on Passage of Senate Health Care Bill

The following statement was issued by Dr. Charmaine Yoest, President of Americans United for Life Action:

“Americans don’t want taxpayer funding for abortions and are opposed to a first-ever, mandatory abortion tax. Knowing this, the bill’s proponents have rushed it through the Senate at a time when Americans are focused on celebrating Christmas with their families.”

Hewitt Research Continues to Show High Rate of COBRA Enrollments Among Subsidy-Eligible Employees.

A new analysis from Hewitt Associates, a global human resources consulting and outsourcing company, indicates that average monthly enrollment rates in COBRA health care plans among subsidy-eligible employees have increased by 20 percentage points since the COBRA subsidy was enacted in March 2009. This comes as President Obama recently signed the Department of Defense Appropriations Act for Fiscal Year 2010, which includes a law that lengthens the duration of the COBRA subsidy from nine months to 15 months for eligible employees and their dependents. It also extends the subsidy to those Americans who lose their jobs on or before February 28, 2010. Hewitt’s analysis examined the COBRA enrollment activity for 200 large U.S. companies representing 8 million employees from March 2009 to November 2009. During that period, monthly COBRA enrollment rates for subsidy-eligible employees averaged 39 percent, compared to 19 percent for the period of September 2008 to February 2009—prior to when the subsidy was enacted.

“The increase we’ve seen in COBRA enrollments since March highlights how important the subsidy benefit has been to families who have been affected by the high rate of unemployment,” said Karen Frost, Hewitt’s Health and Welfare Outsourcing leader. “The subsidy provides laid-off Americans with a cost-effective way to continue getting health insurance coverage, and we expect enrollment rates to remain high until the subsidy expires or the labor market shows signs of improving.”

The COBRA subsidy under the American Recovery and Reinvestment Act of 2009 (ARRA) requires eligible employees to pay 35 percent of the COBRA premium, or about $3,000 a year for the average worker. Under the original COBRA law, most involuntarily terminated workers were required to pay 100 percent of the health care premium plus an additional 2 percent to cover administrative costs. This translates to roughly $8,800 a year in COBRA health care costs for the average worker.

COBRA Enrollments by Industry

Since the subsidy was enacted in March 2009, Hewitt’s analysis shows that companies in the industrial manufacturing and aerospace and defense industries saw the largest overall increases in COBRA enrollment rates for subsidy-eligible employees. In the industrial manufacturing industry, for example, COBRA enrollment rates for eligible employees rose from 7 percent (September 2008 to February 2009) to 67 percent (March 2009 to November 2009). In addition, companies in the aerospace and defense industry saw the rate of COBRA enrollments more than double, from 30 percent (September 2008 to February 2009) to 63 percent (March 2009 to November 2009).

Industry Breakdown of Average Monthly COBRA Enrollment Rates

Avg. Monthly EnrollmentSept. 2008 – Feb. 2009Avg. Monthly Enrollment Mar. 2009 – Nov. 2009
Aerospace & Defense30%63%
Automotive & Transport25%33%
Banking29%50%
Business Services20%42%
Chemicals9%19%
Computer Hardware/Services22%40%
Construction6%26%
Consumer Products54%65%
Electronics55%75%
Energy & Utilities13%22%
Financial Services27%34%
Food & Beverage12%27%
Health Care10%18%
Industrial Manufacturing7%67%
Insurance23%40%
Leisure11%28%
Media13%36%
Pharmaceuticals20%44%
Retail9%24%
Telecommunications27%44%
Other5%16%
Cross Industry Average19%39%

About Hewitt Associates

For more than 65 years, Hewitt Associates (NYSE:HEW) has provided clients with best-in-class human resources consulting and outsourcing services. Hewitt consults with more than 3,000 large and mid-size companies around the globe to develop and implement HR business strategies covering retirement, financial and health management; compensation and total rewards; and performance, talent and change management. As a market leader in benefits administration, Hewitt delivers health care and retirement programs to millions of participants and retirees, on behalf of more than 300 organizations worldwide. In addition, more than 30 clients rely on Hewitt to provide a broader range of human resources business process outsourcing services to nearly a million client employees. Located in 33 countries, Hewitt employs approximately 23,000 associates. For more information, please visit www.hewitt.com.

Source: Hewitt Associates

CBO Double Counts Medicare Savings in the Patient Protection and Affordable Care Act.

The CBO today admitted that it had double counted the savings that would results from the cuts to Medicare included in the Patient Protection and Affordable Care Act (PPACA).

Essentially, the CBO had credited the savings to the Health Insurance Trust Fund (HI) extending the amount of benefits that can be paid out. At the same time, the cuts were also being used to offset the additional costs of providing subsidies to low income uninsureds to all them to buy coverage.

What impact this will have on the passage of the healthcare bill is yet to be determined, but there is already speculation that the healthcare legislation will not be finalized in time for President Obama’s State of the Union Address.

Here is the letter that was posted today on the CBO website:

CBO has been asked for additional information about the projected effects of the Patient Protection and Affordable Care Act (PPACA), the pending health care reform legislation, on the federal budget and on the balance in the Hospital Insurance (HI) trust fund, from which Medicare Part A benefits are paid. Specifically, CBO has been asked whether the reductions in projected Part A outlays and increases in projected HI revenues under the legislation can provide additional resources to pay future Medicare benefits while simultaneously providing resources to pay for new programs outside of Medicare. Our answer is basically no.

How the HI Trust Fund Works

The HI trust fund, like other federal trust funds, is essentially an accounting mechanism. In a given year, the sum of specified HI receipts and the interest that is credited on the previous trust fund balance, less spending for Medicare Part A benefits, represents the surplus (or deficit, if the latter is greater) in the trust fund for that year. Any cash generated when there is an excess of receipts over spending is not retained by the trust fund; rather, it is turned over to the Treasury, which provides government bonds to the trust fund in exchange and uses the cash to finance the government’s ongoing activities. The resources to redeem government bonds in the HI trust fund and thereby pay for Medicare benefits in some future year will have to be generated from taxes, other government income, or government borrowing in that year.

The balance in the trust fund represents the accumulated difference between the fund’s receipts and outlays over time, including interest credited to the fund. Reports on HI trust fund balances from the Medicare trustees and others show the extent of prefunding of benefits that theoretically is occurring in the trust fund. However, because the government has used the cash from the trust fund surpluses to finance other current activities rather than saving the cash by running unified budget surpluses, the government as a whole has not been truly prefunding Medicare benefits.

The Impact of the PPACA on the HI Trust Fund and on the Budget as a Whole

In a report released this afternoon, CBO and the staff of the Joint Committee on Taxation (JCT) estimated that the PPACA, incorporating the manager’s amendment, would reduce Part A outlays by $245 billion and increase HI revenues by $113 billion during the 2010-2019 period. Those changes would increase the trust fund’s balances sufficiently to postpone exhaustion for several years. However, the improvement in Medicare’s finances would not be matched by a corresponding improvement in the federal government’s overall finances. CBO and JCT estimated that the PPACA as amended would add more than $400 billion ($245 billion + $113 billion + interest) to the balance of the HI trust fund by 2019, while reducing federal budget deficits by a total of $132 billion by 2019.

The reductions in projected Part A outlays and increases in projected HI revenues would significantly raise balances in the HI trust fund and create the appearance that significant additional resources had been set aside to pay for future Medicare benefits. However, the additional savings by the government as a whole—which represent the true increase in the ability to pay for future Medicare benefits or other programs—would be a good deal smaller.

The key point is that the savings to the HI trust fund under the PPACA would be received by the government only once, so they cannot be set aside to pay for future Medicare spending and, at the same time, pay for current spending on other parts of the legislation or on other programs. Trust fund accounting shows the magnitude of the savings within the trust fund, and those savings indeed improve the solvency of that fund; however, that accounting ignores the burden that would be faced by the rest of the government later in redeeming the bonds held by the trust fund. Unified budget accounting shows that the majority of the HI trust fund savings would be used to pay for other spending under the PPACA and would not enhance the ability of the government to redeem the bonds credited to the trust fund to pay for future Medicare benefits. To describe the full amount of HI trust fund savings as both improving the government’s ability to pay future Medicare benefits and financing new spending outside of Medicare would essentially double-count a large share of those savings and thus overstate the improvement in the government’s fiscal position.

Kaiser Permanente Bolsters Access to Healthy, Nutritious Food in Hard Times.

With hunger in America reaching its highest level in 14 years, Kaiser Permanente has quadrupled the amount it invests in programs to promote healthy eating during difficult economic times.

In 2009, Kaiser Permanente approved $2.1 million in grants and donations to nonprofit organizations that provide access to healthy foods at food banks and pantries, and that help boost participation in federal nutrition programs. The health care organization’s grants in this area are up from $430,000 in 2008 and $480,000 in 2007.

“When family budgets are tight, people often struggle to put healthy food on their tables,” said Raymond J. Baxter, PhD, senior vice president, Community Benefit, Research and Health Policy, Kaiser Permanente. “We are making investments in short- and long-term strategies to help our members and communities make it through this recession healthy.”

Kaiser Permanente is at the forefront of national efforts to ensure access to healthy foods such as fruits and vegetables. The organization is funding local programs from Hawaii to Washington, D.C., to ease the struggle that many Americans face as they work to put food on the table. Examples include:

  • Maui Food Bank, which is using $50,000 for its “Fresh-4-All” program that provides fresh, locally grown food for the indigent, homeless and at-risk island population. People with diabetes will receive priority for the produce.
  • Loaves and Fishes, Portland, Ore., which is using $60,000 to purchase fruits and vegetables for meals for seniors in Multnomah, Washington, and Clark counties in Oregon and Washington.
  • California Association of Food Banks, which will use $200,000 to help its networks of food banks improve the nutritional quality of food distributed through food banks and pantries. For example, it will help connect food banks to local farmers, and it will help food banks develop nutritional guidelines for food they distribute.
  • Manna Food Center of Gaithersburg, Md., is using $100,000 toward expanding its “Smart Snacks” program that provides a bag of nutritious, kid-friendly food to more than 1,050 elementary school children each week at 32 schools. In addition, $50,000 will fund a new program, “Fresh Food for Families,” which brings local farm produce to families in need.

Kaiser Permanente also is funding innovative programs designed to increase participation in government supported food programs, including school meal and food stamp programs, and to bring healthier food to participants in those programs. Examples include:

  • California Food Policy Advocates, which will use $200,000 to provide better access to food for Californians who are experiencing economic difficulty, improve access to food stamps and increase participation in school breakfast and other meal programs.
  • Food Research and Action Center, Washington, D.C., which will use $150,000 to work with anti-hunger advocates in Kaiser Permanente regions to remove barriers such as duplicative office visits, fingerprinting requirements and cumbersome forms that unnecessarily consume the time of overstretched caseworkers and prevent eligible people from receiving food stamp benefits. They also will assist school districts to help eligible families participate in school lunch and school breakfast programs.
  • Coalition to End Hunger, of Denver, will use $80,000 to support state- and county-level changes that increase access to food stamps as well as school breakfast and lunch programs.
  • The California Departments of Public Health and Social Services are using a $200,000 grant to design a Healthy Purchase Pilot Program, which would offer a rebate to food stamp recipients who increase their purchase and consumption of healthy fruits and vegetables.

“Lack of access to healthy foods among low-income populations — seniors, children, working adults struggling in the recession and others — poses a significant risk to our communities’’ health,” says James D. Weill, president of the Food Research and Action Center. “At a time when much philanthropic giving has been scaled back, it is great to see Kaiser Permanente expanding its commitment to these critical programs. This will make a real difference in a lot of places.”

The $2.1 million investment in Healthy Eating in Hard Times is one piece of Kaiser Permamente’s more than $1 billion annual commitment to improve the health of the communities it serves.

About Kaiser Permanente:
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.