Politics and Policy

PROVIDING BETTER quality care at lower cost has long been the Holy Grail of healthcare, but reaching this goal has been more difficult and controversial than anticipated.

Officials at the Centers for Medicare and Medicaid Services (CMS) began smiling last month. They were watching the letters and applications roll in from MCOs--;a sign that seniors will be able to obtain care from a large number of local PPOs (preferred provider organizations) beginning next January.

IN HIS FIRST few days as Secretary of the Department of Health and Human Services (HHS), Mike Leavitt made waves by announcing plans to revise Medicaid and ensure drug safety.

President George W. Bush began his second term by launching a high-profile campaign to limit skyrocketing medical malpractice insurance premiums for physicians and hospitals.

In a surprise move, President George Bush named former Utah Governor Michael Leavitt as the next secretary of the Department of Health and Human Services.

Major initiatives to expand healthcare coverage to the uninsured or reform Medicaid are low on the priority list at the Bush White House.

Major initiatives to expand healthcare coverage to the uninsured or reform Medicaid are low on the priority list at the Bush White House.

Health and Human Services Secretary Tommy Thompson happily announced last month that Medicare beneficiaries will have more coverage choices in 2005.

The cost of family coverage under a PPO hit $10,000 this year, boosting concerns about the growing unaffordability of healthcare and future increases in the number of uninsured.

In late July, Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mark McClellan unveiled a massive proposed regulation for implementing the Medicare Modernization Act. The hundreds of pages of fine print (published in the Aug. 3, 2004, Federal Register) describes requirements for Medicare Advantage (MA) plans, subsidies for employers who continue retiree drug benefits, and rules to ensure that prescription drug plans (PDPs) provide adequate and appropriate medicines for seniors. There is considerable detail on PDP operations and benefit design, including copays and quality improvement programs, which apply to MA plans providing drug coverage to Medicare beneficiaries.

Recent legislation and regulations are encouraging payers and health plans to offer individuals more coverage options under the "consumer-directed health plan" label. Last year's Medicare Modernization Act (MMA) expanded tax breaks that make health savings accounts (HSAs) more attractive.

Healthcare access, Medicare rates will be hot issues in the election year debates

Democrats cry foul as analysts describe big jumps in rates for Medicare Advantage plans

This primary issue figures into upcoming elections

McClellan takes over at CMS amidst escalating battle over drug imports

MCOs enhance benefits, cut fees to attract more Medicare beneficiaries

Election year campaigning focuses attention on rising healthcare costs and the need for universal coverage

MCOs seek to manage healthcare spending while expanding DM activities in Medicare

As the pool of uninsured increases by 2.4 million, health plans look to offer more cost-management options

M+C plans eye expanded coverage for seniors if Congress boosts rates

MCOs want flexibility while analysts challenge the ability of private plans to control costs

Policy makers question whether increased reliance on health plans will provide quality care while controlling costs

Blocking consumers from using health care resources backfired in a big way. Now the big idea is to put consumers in charge. Is the concept on target?

High court rulings shape health plan policies.

Congress rejects White House Medicare pharmacy plan while moving forwardwith its own reform strategy

MCOs are on the front lines to deliver benefits, curb Medicare and Medicaid spending

A sharp rise in healthcare spending puts the spotlight squarely on theerosion of managed care

Initiatives that promote industry competition remain key to modernizingthe nation's healthcare system

Legislators seek Medicare "givebacks," malpractice reform,tax credits for health insurance

Officials don't expect the situation to improve as tax revenues declineand healthcare costs continue to rise