Aarp Health Insurance

Aarp Health Insurance

In this area AARP Health Insurance for Young Adults

Friendship for the Advancement of Retired personnel (AARP) was ongoing near 50 years past by Dr. Ethel Andrus in 1958. The non-profit organization give services and benefits with the intention of primarily focus on people 50 years old and up. AARP has approximately 40 million members right through the United States, the constituency of Columbia, Puerto Rico and the Virgin Islands. Equally confirmed on its authoritative website the organization's mission "is to improve the quality of life for all equally we age, leading clear social exchange and delivering value to members from side to side information, advocacy and service." Benefits this non-profit organization provide its members include: Discounts on travel prices and retail products, advocacy around issues impacting seniors, information together on and offline and community services such equally driver training. Yet, AARP offers health insurance benefits for other at that time senior citizens. The organization furthermore offers health services and benefits by means of sound firms for young adults. To get benefit of these health insurance programs young adults, personnel younger than 50 years, want require to become frequent members of AARP.

Frequent Memberships
Equally an frequent member, you can get benefit of AARP's dental insurance program which is existing to members of all ages. The dental program is provided by Delta Dental Insurance Program. Other than 140,000 dentists are in the program which allows members to frequently stay their current dentist as they sign up for the program. The dental program is administered in more than a few states in the United States. To think it over if your state participates in the program, you can visit the provider's website. Here are two dental plans you can point out as of in the program depending on the type of coverage you aspire. Together plans provide coverage for services counting diagnostic and preventive care, oral surgery, starting place inland waterway and filings. Deductibles are $50 and $100 a time depending on the plan you excellent.

Idea and Prescription Discounts
Bonus health insurance coverage for young adults includes lengthy term care insurance, idea and prescription discounts. Here is a $19.95 once a year fee to participate in the prescription discount program. Walgreens Health Initiative administers this discount program with the intention of allows young adults to receive their prescriptions from side to side the mail if they point out to do so. To think it over the savings for a fastidious prescription, young adults can look for the administrator's site. For idea, savings for young adults are at 30% for eyewear and 20% for contacts. Companies participating in the program are Pearle idea, Lens Crafters, Sears Optical and JCPenney Optical.

Fitness Programs
Young adults can furthermore save on fitness programs at Curves, Gold's aerobics studio and ACE. Here is a 20% savings off Gold's aerobics studio membership fees and a 15% savings off the expenditure of a personal teacher. Members can save $100 off Curve's enrollment expenditure.

Easy Access to Medical equipment
AARP frequent members, persons under 50 years of age, can get benefit of medical supply services which allows members to refill their medical equipment without leaving the comforts of their home. Membership in Medicare is vital to participate in this program.

Assemble Health Insurance
The state with the intention of you live in may provide bonus benefits for being an AARP frequent member. You strength furthermore befall able to participate in assemble health insurance programs existing by AARP. If you are the partner of an AARP satiated member, you can get benefit of AARP's health insurance plan existing from side to side Aetna. Dependent children of satiated AARP members may furthermore get benefit of the organization's premiere health insurance plan. If you are a young adult, to befall eligible for this premiere health insurance program you should befall the dependent of a satiated AARP member linking 19 and 24 years old, unmarried and a satiated time student.

College Grads: Will you be needing health insurance after graduation?

With studies showing that 34% of recent college spend some time uninsured after graduating, it's no surprise that health insurance is on their minds within days and weeks of graduation. With the rising costs of health care, some people are finding it difficult to find affordable coverage. Two-thirds of uninsured young adults skip needed care due to high costs, so whether your employer does not offer health coverage, or you are self employed, you may find yourself in a position where you need to seek your own health insurance policy. Luckily, at C & S, we can help you, so feel free to visit our website or call for more information! Also, for some helpful tips and advice, take a look at the information below about how to get health insurance from this CNN article!

1. Know your rights
While many states kick you off your parents' policy after you graduate from college, other states require your parents' insurance to stick with you, sometimes until you're 26.
2. Consider COBRA
If your insurance company boots you from your parents' policy, you can pay to stay on under the COBRA laws. Because only you are going on COBRA, not your parents, it may not be as expensive as you think. It's worth checking it out.
3. Be wary of short-term policies
If you think you might land a job soon, it might be tempting to buy a short-term policy. But before you sign on the dotted line, Karen Pollitz, project director of Georgetown University's Health Policy Institute, says to read the fine print. Some short-term policies can kick you off at the beginning of each month if you've become an expensive person to insure, she says. "If you expect to start a new job in two months, but you get hit by a car in two weeks, your month-to-month policy will end mid-treatment and you'll be stuck with the remaining bills," she warns.
4. Shop around for a policy
Prices vary widely by location. We asked the folks at ehealthinsurance.com to price out some policies for us. For example, a healthy 24-year-old in Dallas, Texas, can get a policy for $117 a month, or in Chicago, Illinois, for $136 per month, or Miami, Florida, for $208 a month. All these policies have a $1,000 deductible, which means the insurance doesn't start paying until you pay $1,000 out of your own pocket.
5. Consider graduate school
Susan Vance, who teaches a class on financial responsibility to students at St. Mary's College in Notre Dame, Indiana, says you might want to consider graduate school, since policies generally will cover dependents as long as they're students. "I actually know someone who really didn't want to go to school but did so primarily for the insurance coverage," she says. "I think most college kids take it for granted," she says. "We expect to have it. But it goes away at graduation."

Collateral Source Rule Protects Tort Plaintiff's Recovery for Health Insurance Discounts

Here is an interesting case. The plaintiff in an auto accident sued for her full damages resulting from the accident. The defendant was found liable but sought to reduce the award by the amount of the difference between what her medical insurance actually paid and the total for which she was liable to the providers. Thus, the case focused upon whether the collateral source rule protected not only the amounts paid by the medical insurer, but also the huge discounts which often reach into the stratosphere that the insurers squeeze out of the providers.

In Howell v. Hamilton Means and Provisions, 2009 DJDAR 16748 (11/23/2009), the California Fourth District Court of Appeal ruled that the plaintiff was indeed entitled to her full medical expenses and the defendant was not entitled to any reduction reflecting the negotiated price reduction obtained by the insurer. The insurance company lobby filed an amicus brief in support of the defendant. The court disagreed with the analysis of other appellate court decisions and concluded that any abrogation of the collateral source rule should be undertaken by the Legislature, not by the courts.

This case is an unusual example of a conservative leaning court (we do not legislate) ultimately filing a decision that clearly supports the plaintiff's bar.

The decision has been published. Given the conflict amoungst several appellate courts in Califonria on this subject, it will be interesting to see whether or not the California Supreme Court takes this decision for review (which effectively removes it from the books) or depublishes it. For those of you not from California, seeking depublication is a tactic that insurance companies often seek to use to remove the precedential value of adverse decisions because a depublished decision cannot be cited by others as precedent, even though it remains the law of the case. The Supreme Court could also let the decision stand. I suspect that the insurance company lobby (openly or through the defendant) will move the appellate court to de-publish the decision and, if that maneuver fails, have the defendant seek review by the state Supreme Court.

Stay tuned.

Health Care Reform Likely to Include More Taxes for Many Americans

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As a presidential candidate, Barack Obama had one central message to middle-income Americans: no new taxes. And since taking office, the president has repeatedly pledged not to raise taxes on families making less than $250,000 a year.

But as a massive health care reform bill inches closer to reality, middle-class Americans, as well as high income earners, can expect some sort of increase in what they pay into government coffers, say Republican critics and some fiscal watch dog groups.

The Senate Finance Committee health care reform bill, which could hit the Senate floor as early as this week, would impose new taxes on insurance companies, drugmakers and medical device manufacturers.

It would also impose a 40 percent tax on the portion of insurance premiums exceeding $8,000 a year for individuals and $21,000 a year for family plans. That tax would be imposed on insurance companies, though it would likely be passed on to consumers, including many middle-income families, say experts.

Last week, Senate Majority Leader Harry Reid was considering a proposal to increase the Medicare payroll tax on high-income workers to help offset the costs of providing health insurance to millions of Americans.

But several Democratic senators are urging Reid to propose extending the Medicare payroll tax to income other than wages, such as capital gains, dividends and rental income. Democrats say that could generate revenue from wealthy households who often get a greater share of their income from sources other than wages.

Some Republicans and Wall Street investors say tapping into high-end earners and capital gains will soak the rich and hurt an already ailing economy.

"Could there be a more efficient way to kill our halting recovery from recession than to have Harry Reid plot in secret to raise taxes?" says Donald Luskin, chief investment officer at Trend Macrolytics LLC. "Have we learned no economic lessons from the Depression?"

The recently passed House bill would impose a 5.4 percent income tax on individuals making more than $500,000 and joint filers making more than $1 million.

The top income tax rate is 35 percent. If existing Bush-era tax cuts expire in 2011, as President Obama has called for, the top rate would grow to 39.6 percent. The new health care tax would further increase that to 45 percent. The House bill would also impose a 2.5 percent tax on the sale of medical devices.

Paying a Fair Share

The House bill would raise $460 billion over the next decade from new income taxes that mostly target the wealthy.

"The public pretty much thinks the richer people in America ought to pay their fair share," says House Majority Leader Steny Hoyer told ABC News last week. "They don't think they're paying their fair share."

But Democratic Sen. Ben Nelson of Nebraska says he'll vote to block any health care bill that looks like the bill passed by the House. "The costs are extraordinary associated with it," he told ABC News. "It increases taxes in a way that will not pass in the Senate. I won't vote to move it."

The House GOP bill, which was rejected a week ago, had no new taxes. Republicans would get savings by capping medical liability awards, stepping up efforts to fight Medicare and Medicaid fraud, and setting up an approval process for generic versions of high-tech drugs.

All of the health care packages are expensive. The House bill is projected to cost $1.2 trillion over 10 years and the Senate Finance Committee bill is projected to cost $829 billion. Taxes will increase if any of the plans are enacted, say experts.

According to a report by the Tax Foundation, a tax research group based in Washington, D.C., wealthy taxpayers in 39 states could pay a top tax rate higher than 50 percent by 2011.

The report combined states' average local tax rates, top state and federal rates with the 2.9 percent Medicare tax and the proposed 5.4 percent health surtax.

Also possibly adding to middle-class tax burdens is a provision in the House plan that requires all Americans to have health insurance.

Large companies would have to offer coverage to their employees, and both consumers and companies would be slapped with penalties if they defy the government's mandate.

"If you choose not to get insurance, you get hit with an excise tax," says Luskin of Trend Macrolytics LLC. "Which is a fancy way of saying a fine or a penalty."

For low-income Americans, the bill would provide subsidies for buying insurance if they don't receive it through an employer. It would also create a federally regulated insurance exchange where individual Americans could shop for coverage.

"There are harmful taxes and taxes that aren't as harmful," says Gerald Prante, a senior economist at the Tax Foundation. Prante says ultimately the final health reform bill will raise taxes on the general public.

"Taxes are necessary evil to finance governments."

Health Benefits Direct Announces Third Quarter 2009 Financial Results

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Health Benefits Direct Corporation (OTCBB: HBDT), a leading technology innovator in the marketing, sales and administration of a range of insurance technology products, today announced its financial results for the third quarter ended September 30, 2009.

During the third quarter, the Company continued its previously announced restructuring activities. As part of these restructuring efforts, in the first quarter of 2009, the Company ceased selling health and life insurance products to individuals and families and disposed of a significant portion of its agency business, which is now classified as discontinued operations in the Company's financial statements.

Third Quarter Highlights

-- Revenues from continuing operations of $1.5 million, compared to $1.4
million in the third quarter of 2008. The increase was due primarily to
increased InsPro Technologies (formerly Atiam Technologies LLC) revenues
from ASP, maintenance and licensing agreements.
-- Operating expenses for continuing operations of $3.7 million, compared
to $3.0 million in the third quarter of 2008. The increase was primarily
attributable to an increase in InsPro staffing and technology consultants
to support current client requirements and growth plans.
-- Net loss from continuing operations of $2.2 million, compared to $1.7
million in the third quarter of 2008. This increase is consistent with the
Company's strategy to enhance InsPro Technologies' capacity by increasing
expenditures for marketing, sales, infrastructure and product development.
-- Total net loss from continued and discontinued operations of $1.4
million or ($0.03) per share, compared with total net loss of $1.7 million,
or ($0.04) per share in the third quarter of 2008.


"We continue to make progress with our initiatives to further align our operations and cost structure with our promising technology business," said Anthony Verdi, Acting Principal Executive Officer of Health Benefits Direct and Chief Financial Officer. "We realized an $800,000 net gain from discontinued operations in the third quarter as we continue to reduce expenses that are not essential to our core technology business.

"In conjunction with our plan to continue to invest in our promising subsidiary, InsPro Technologies, we are working on obtaining additional financing through a rights offering of up to $8 million, which will give all of our shareholders the opportunity to participate in an equity investment in the Company on the same economic terms as our private placements in 2008 and 2009," Mr. Verdi concluded.

About Health Benefits Direct Corporation

Through its subsidiary, InsPro Technologies, Health Benefits Direct offers InsPro software, an internet-based marketing and administration system used by Insurance carriers and Third Party Administrators. Through its subsidiary, Insurint Corporation, Health Benefits Direct provides a proprietary, professional-grade, web-based agent quote engine portal that aggregates real-time quotes from more than 100 health insurance carriers, life insurance carriers and carriers of related insurance products. www.healthbenefitsdirect.com

Forward-Looking Statements

In addition to historical facts or statements of current condition, this press release contains forward-looking statements within the meaning of the "Safe Harbor" provisions of The Private Securities Litigation Reform Act of 1995, including statements regarding the growth potential of our technology platforms and obtaining additional financing through a rights offering to fund our operations. Forward-looking statements provide Health Benefits Direct's current expectations or forecasts of future events. Moreover, Health Benefits Direct cautions readers that forward-looking statements are subject to certain risks and uncertainties, which could cause actual results to differ materially from the statements made, including risks described in Health Benefit Direct's most recent Quarterly Reports on Form 10-Q or Annual Reports on Form 10-K filed with the Securities and Exchange Commission and available on Health Benefits Direct's website at www.healthbenefitsdirect.com. These documents are also available on the Securities and Exchange Commission's website at www.sec.gov. Health Benefits Direct does not undertake any obligation to update any forward-looking statement to conform the statement to actual results or changes in expectations.

Experts Split Over How Public Health Insurance Would Affect California

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Although supporters of a government-run public health insurance option say the proposal could improve health care quality in California, others say the plan likely would have higher premium costs, the San Jose Mercury News reports.

Proponents

Supporters say California's relatively limited health insurance marketplace could benefit from greater competition. Although the state currently has five major insurers, Anthem Blue Cross and Kaiser Permanente control about three-fifths of the state's health insurance market, according to the American Medical Association.

Newly elected Rep. John Garamendi (D-Calif.), former California insurance commissioner, said a more competitive health insurance marketplace could motivate insurers to improve their business practices so they do not lose members to the public plan.

Lucien Wulsin -- a health care attorney and director of the Santa Monica-based Insure the Uninsured Project -- said a government-run plan also could experiment with different incentive models and spur innovation in the health care system.

Other experts note that California has a large pool of residents who might seek coverage under the public plan. The state currently has 6.8 million uninsured residents and 2.7 million residents who purchase coverage on the individual insurance market.

Skeptics

Other analysts say relatively few Californians would seek coverage under a government-run plan because it might have higher premiums than private health plans.

The Congressional Budget Office predicts that fewer than one million Californians would join the public plan. The office said the option is likely to attract less healthy residents, who could drive up overall premium costs.

A government-run plan also might have difficulty securing lower premiums because the House bill (HR 3962) would require the plan to negotiate payments with hospitals and physicians, instead of tying payments to Medicare rates. Experts say some health care providers might choose not to participate in the public plan if they are dissatisfied with the proposed payment rates.

Patrick Johnston, president and CEO of the California Association of Health Plans, said the House's public insurance option likely would have only a modest impact on California.

Other observers note that it remains unclear whether final health care reform legislation will include a public health insurance option (Zapler, San Jose Mercury News, 11/15).

Come Medicare Part D time (which is now), don't feel daunted -- help is at hand

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Already the clock is ticking down toward the end of the enrollment -- and re-enrollment -- period for Medicare Part D. It opened Sunday and will end Dec. 31.

Need help figuring out what your drug needs are? We'll be offering advice in the Health section soon. In the meantime, here's an earlier guide to help you sort through your options...

GETTING STARTED

New to Medicare Part D? Start at www.medicare.gov or call 800-MEDICARE (633-4227) for a compendium of all things Part D.

Part D veteran? Head right to plan comparisons at Formulary (Drug) Finder. This option lets you compare the premiums, deductibles and drug co-pays for plans in your area. Be forewarned: The task is tedious.

WHO CAN HELP

My Medicare Matters, offered by the National Council on Aging, presents the very complex Part D information in simple terms and divides it into digestible chunks before sending you off to the next section.

The Medicare Rights Center, an advocacy group based in New York and Washington, D.C., offers Medicare Part D telephone counseling at (800) 333-4114 -- with plenty of advice on the website.

California Health Advocates is a nonprofit Medicare education and advocacy group with advice perhaps most useful, our earlier report said, for already-Medicare-savvy beneficiaries and caregivers.

The Health Insurance Counseling and Advocacy Program offers one-on-one counseling on Medicare, managed care and long-term care. A call to (800) 434-0222 is routed to the closest office.

The National Alliance for Hispanic Health, an advocacy group, can answer questions about Part D benefits for Spanish-speaking beneficiaries. Call (866) 783-2645.

Abortion Rights Groups Mobilize Against Stupak Amendment

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Abortion rights advocates are ratcheting up their pressure on lawmakers to drop the proposal added to the House health care bill that would restrict health insurance coverage for abortions.

The Center for Reproductive Rights is launching an ad campaign today to emphasize that, if the Stupak amendment were to pass in the final health care bill, millions of women could potentially lose the coverage for abortions they currently have in their health care plans.

The group is running an ad online and on cable markets in the Washington area, leading up to the abortion debate that is sure to spring up in the Senate.

The so-called Stupak amendment would prevent women who receive federal subsidies for health insurance from purchasing plans that cover abortion. It would also explicitly ban abortion coverage from the government-run plan, or "public option." It would also essentially prevent private insurers from selling plans on the national health insurance exchange that cover abortion.

In other words, women who intend to use government subsidies for health care costs could be forced to switch plans. Additionally, if a woman's employer were to start offering coverage under the national health insurance exchange, she could potentially have to switch plans.

"Anti-choice forces in Washington are trying to use this important moment of health insurance reform to expand restrictions on abortion coverage in private insurance plans," Center for Reproductive Rights President Nancy Northup told CBSNews.com. The extent of the amendment's impact on coverage is surprising, she said.

"People who have terminations in the second trimester because of fetal abnormalities are also not going to be covered, and that's going to be stunning to people," Northup said. "This is a wake up call for pro-choice Americans."

Abortion rights advocates say the amendment has galvanized their supporters. To prove that, NARAL Pro-Choice America today delivered a petition with 97,218 signatures to Senate Majority Leader Harry Reid, asking that he leave the Stupak amendment out of the Senate bill. Working with state affiliates and other progressive partners, NARAL collected the signatures in 72 hours.

"America’s pro-choice majority is speaking up loudly and clearly," NARAL President Nancy Keenan said in a statement. "As the fight for health reform moves forward, we are making sure Sen. Reid and his colleagues understand that adding the anti-choice Stupak-Pitts language to the Senate bill is not an option."

NARAL is also launching this week a set of automated calls in 17 states that will allow NARAL supporters to connect with their senators with the touch of a button. The organization is also engaging its e-mail network of half a million supporters to rally opposition to the Stupak amendment. NARAL will be communicating with all 100 senators in the upcoming weeks, NARAL Communications Director Ted Miller told CBSNews.com.

Planned Parenthood is also engaging its supporters online, rallying support on progressive blog networks and via social networking. It is planning a national "day of action" for December 2.

Health Reform: More on the Wrong Way Cost Curve

health insurance

In my Newsweek column this week ("Obama's Malpractice: Why the health-care bill isn't reform"), I argued that-contrary to the Administration's claims-none of the various proposals now floating around Congress would reduce future budget deficits or the rapid rise in national health spending. Quite the opposite: the proposals would probably increase both deficits and national health spending. Now comes Richard Foster, chief actuary of the Centers for Medicare and Medicaid Services (CMS), a federal agency, making the same points with a lot more detail. In a study published after my column was written, Foster estimates that H.R. 3962, which passed the House of Representatives on Nov. 7, would raise national health spending by about $289 billion from 2010 to 2019. He also casts considerable doubt on whether the "savings" in Medicare that are used to pay for expanded insurance coverage would actually materialize; if not, the expansion of health-care would lead to higher federal budget deficits.

By Foster's estimates, H.R. 3962 would substantially reduce the number of uninsured Americans, from a projected 57 million in 2019 to 23 million. Most of the newly-insured would receive coverage under a liberalized Medicaid, the joint federal-state program aimed at the poor; many others would entitled to federal subsidies to buy insurance on "exchanges" where a number of insurers would offer competing plans. The costs of the expanded coverage would total about $935 billion over the 2010-2019 decade (some other non-insurance provisions would add slightly to costs). Meanwhile, "savings" mainly from Medicare would cover slightly more than half those costs. High taxes, not included in Foster's analysis, would pay for most of the rest. (Though Foster's office is an arm of CMS, it provides independent analyses of proposals and costs.)

But, Foster says, many of the Medicare "savings" may be "unrealistic." Reimbursement rates for hospitals, skilled nursing facilities, home health agencies and other health-care providers would be reduced from existing law. The assumption is that these providers would become more efficient and, therefore, could survive without the higher payments. This could be wishful thinking, Foster suggests. Providers that depend heavily on Medicare "could find it difficult to remain profitable and might end their participation in the program (possibly jeopardizing access to care for beneficiaries)." In that case, Foster indicates, Congress might reverse some of the reimbursement reductions leading to "significantly smaller actual savings." Budget deficits would increase correspondingly.

Small Businesses Face Health Insurance Rate Hikes in Massachusetts

health insurance

Some commentators have called the Massachusetts health reform plan adopted a few years ago "Obama-like." But health reform in the Bay State has not meant the end of insurance premium woes for small employers. The Boston Globe reports that small business insurance rates are jumping by the double digits.

At a time when both the state and the nation are struggling to rein in health care costs, many small businesses in Massachusetts say they’re receiving the largest premium increases in years for their Jan. 1 renewals. Insurers in September said they expect to raise premiums an average of 10 percent next year, but some employers are facing increases that are double or triple that - or even higher.

While all of the state’s health insurers have been jacking up rates for small businesses, which lack the negotiating might of larger enterprises with hundreds or thousands of employees, some of the steepest increases have been coming from Blue Cross and Blue Shield of Massachusetts. The Boston insurer, the state’s largest, has in the recent past offered lower base rates than many of its rivals.

One possible cause? The state's universal mandate has forced high-cost individuals into small-business insurance plans.

Trauma patients without health insurance are much more likely to die

health insurance

A new study shows the odds of dying from a traumatic injury soar for the uninsured. ER physicians say they're surprised by the findings.

Patients who lack health insurance are more likely to die from car accidents and other traumatic injuries than people who belong to a health plan -- even though emergency rooms are required to care for all comers regardless of ability to pay, according to a study to be published Tuesday.

An analysis of 687,091 patients who visited trauma centers nationwide between 2002 and 2006 found that the odds of dying following an accidental injury were almost twice as high for the uninsured than for patients with private insurance, researchers reported in Archives of Surgery.

Trauma physicians said they were surprised by the findings, even though a slew of studies had previously documented the ill effects of going without health coverage. Uninsured patients are less likely to be screened for certain cancers or to be admitted to specialty hospitals for procedures such as heart bypass surgery, for example. Overall, about 18,000 deaths each year have been traced to a lack of health insurance.

But insurance status isn't supposed to be a factor for trauma patients. The Emergency Medical Treatment and Active Labor Act, passed by Congress in 1986, guarantees that people brought to emergency rooms get all necessary treatment no matter what kind of insurance they do -- or don't -- have.

The research team from Harvard University and Brigham and Women's Hospital in Boston used information from 1,154 U.S. hospitals that contribute to the National Trauma Data Bank. The team found that patients enrolled in commercial health plans, health maintenance organizations or Medicaid had an equal risk of death from traumatic injuries when the patients' age, gender, race and severity of injury were taken into account.

The risk of death was 56% higher for patients covered by Medicare, perhaps because the government health plan includes many people with long-term disabilities, said Dr. Heather Rosen, who led the study while she was a research fellow at Harvard Medical School.

However, the risk of death was 80% higher for patients without any insurance, according to the report.

The researchers also did a separate analysis of 209,702 trauma patients ages 18 to 30 because they were less likely to have chronic health conditions that might complicate recovery. Among these younger patients, the risk of death was 89% higher for the uninsured, the study found.

Rosen, now a surgical resident at USC's Keck School of Medicine, said the group expected to find at least some disparity based on insurance status. But she said the group was surprised at the magnitude of the gap.

Dr. Frank Zwemer Jr., chief of emergency medicine for the McGuire VA Medical Center in Richmond, Va., said he was "kind of shocked. "

"We don't ask people, 'What's your insurance?' before we decide whether to intubate them or put in a chest tube," said Zwemer, who wasn't involved in the research. "That's not on our radar anywhere."

The researchers offered several possible explanations for the findings. Despite the federal law, uninsured patients often wait longer to see doctors in emergency rooms and sometimes visit ERs at several hospitals before finding one that will treat them. Other studies show that, once they're admitted, uninsured patients receive fewer services, such as CT and MRI scans, and are less likely to be transferred to a rehabilitation facility.

Patients without insurance may have higher rates of untreated underlying conditions that make it harder to recover from trauma injuries, the researchers said. They also may be more passive with doctors and nurses since they don't interact with them as often. All of these factors could influence whether a trauma patient is able to recover from his or her injuries.

But the link could also be coincidental, the authors acknowledged. Perhaps the hospitals that have fewer resources at their disposal also happen to see the most uninsured patients, they said.

The types of injuries may differ too, Zwemer said. Gunshot and stabbing victims were much more likely to die from their wounds than other trauma patients tracked in the study. These people are generally uninsured, but the type of injury -- not insurance status -- is the reason for their higher fatality rates, he said.

More research is needed to figure out whether lack of insurance actually harms trauma patients or whether the data simply reflect a correlation, said Dr. A. Brent Eastman, chair of trauma at Scripps Memorial Hospital in La Jolla.

The issue is particularly relevant as Congress and the Obama administration weigh various measures to reduce the number of uninsured Americans, he wrote in a short critique that accompanied the study. More than 45 million Americans lacked health insurance in 2007, and another 10 million people will join their ranks over the next decade, according to government estimates.

"Being uninsured is an overriding problem in our healthcare system and is why we need healthcare reform," Eastman said.

AP Poll: Americans fret over health overhaul costs

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WASHINGTON — It's the cost, Mr. President. Americans are worried about hidden costs in the fine print of health care overhaul legislation, an Associated Press poll says. That's creating new challenges for President Barack Obama as he tries to close the deal with a handful of Democratic doubters in the Senate.

Although Americans share a conviction that major health care changes are needed, Democratic bills that extend coverage to the uninsured and try to hold down medical costs get no better than a lukewarm reception.

The poll found that 43 percent oppose the health care plans being discussed in Congress, while 41 percent are in support. An additional 15 percent remain neutral or undecided.

"Well, for one, I know nobody wants to pay taxes for anybody else to go to the doctor — I don't," said Kate Kuhn, 20, of Acworth, Ga. "I don't want to pay for somebody to use my money that I could be using for myself."

There's been little change in broad public sentiment about the overhaul plan from a 40-40 split in an AP poll last month, but not everyone's opinion is at the same intensity. Opponents have stronger feelings than do supporters. Seniors remain more skeptical than younger generations.

The latest survey was conducted by Stanford University with the nonprofit Robert Wood Johnson Foundation.

When poll questions were framed broadly, the answers seemed to indicate ample support for Obama's goals. When required trade-offs were brought into the equation, opinions shifted — sometimes dramatically.

In one striking finding, the poll indicated that public support for banning insurance practices that discriminate against those in poor health may not be as solid as it seems.

A ban on denial of coverage because of pre-existing medical problems has been one of the most popular consumer protections in the health care debate. Some 82 percent said they favored the ban, according to a Pew Research Center poll in October.

In the AP poll, when told that such a ban would probably cause most people to pay more for health insurance, 43 percent said they would still support doing away with pre-existing condition denials, but 31 percent said they would oppose it.

Costs for those with coverage could go up because people in poor health who'd been shut out of the insurance pool would now be included, and they would get medical care they could not access before.

"I'm thinking we'd probably pay more because we would probably be paying for those that are not paying. So they got to get the money from somewhere. Basically I see our taxes going up," said Antoinette Gates, 57, of Atlanta.

The health care debate is full of such trade-offs. For example, limiting the premiums that insurance companies can charge 50-year-olds means that 20-year-olds have to pay more for coverage.

"These trade-offs really matter," says Robert Blendon, a professor at the Harvard School of Public Health who follows opinion trends. "The legislation contains a number of features that polls have shown to be popular, but support for the overall legislation is less than might be expected because people are worried there are details about these bills that could raise their families' costs."

If the added costs — spread over tens of millions of people — turn out to be small, it may not make much difference, Blendon said. But if they're significant, Obama could be on shaky ground in the final stretch of his drive to deliver access to health insurance to most Americans.

More than 4 in 5 Americans now have health insurance, and their perceptions about costs are key as Obama tries to rally his party's congressional majority. In the House, Democrats came together to pass their bill. In the Senate, Democratic liberals and a smaller group of moderates disagree on core questions even as Majority Leader Harry Reid, D-Nev., prepares to take legislation to the floor.

The poll suggests the public is becoming more attuned to the fact that in health care, details can make all the difference.

For example, asked if everyone should be required to have at least some health insurance, 67 percent agreed and 27 percent said no.

The responses flipped when people were asked about requiring everybody to carry insurance or face a federal penalty: 64 percent said they would be opposed, while 28 percent favored that.

Both the House and Senate bills would require all Americans to get health insurance, either through an employer, a government program or by buying their own coverage. Subsidies would be provided for low-income people, as well as many middle-class households.

And there would also be a stick — a tax penalty to enforce the coverage mandate.

"I think it's crazy. I think it infringes on our rights as a citizen, forcing us to do these things," said Eli Fuchs, 26, of Marietta, Ga.

Among Democrats, only 12 percent oppose the broad goal of requiring insurance. But 50 percent oppose fines to enforce it.

The poll found a similar opinion shift on employer requirements: 73 percent agreed that all companies should be required to give their employees at least some health insurance.

Yet when asked if fines should be used to enforce such a requirement on medium and large companies, support dropped to 52 percent. Uninsured workers are concentrated in small companies.

The poll was based on land line and cell phone interviews with 1,502 adults from Oct. 29 to Nov. 8. It has a margin of error of plus or minus 2.5 percentage points. The interviews were conducted by GfK Roper Public Affairs and Media. Stanford University's participation was made possible by a grant from the Robert Wood Johnson Foundation, a nonpartisan organization that conducts research on the health care system.

Pelosi defends jail time and fines for those without health insurance

health insurance

The Speaker of the House opines it is unfair for people not to have health insurance and pass on costs of possible illnesses to the rest of us but it is, however, fair for people not to have health insurance and pass on costs of purposeful provision of health insurance to the rest of us.

Jim Cooper, Nashville's Democratic House member, voted for Speaker Pelosi's bill. Someone should ask Representative Cooper what he believes is fair.

PRINCETON: Pelosi visits UMC, touts health reform bill

health insurance

House Speaker Nancy Pelosi and U.S. Rep. Rush Holt, in a Saturday press conference at University Medical Center at Princeton, urged support for the health care reform bill passed by the House of Representatives' Democratic majority.

Acknowledging that the bill still faces a difficult path in the U.S. Senate and, ultimately, a conference committee, both Ms. Pelosi and Rep. Holt, who represents Mercer County, expressed optimism that some form of the bill's public insurance option would reach President Barack Obama's desk.

Speaker Pelosi, who noted the president's stated preference that any health reform bill provide a insurance for those who cannot get it through their employers, said the public option in the House bill would serve that purpose by creating an exchange in which health insurance could be purchased directly at affordable rates. She argued that the public option would "hold the insurance companies accountable" by offering competitive rates.

Ms. Pelosi was asked about criticism from Republican opponents of the bill who say it will inhibit small business growth and force insurance companies to compete with rates unfairly subsidized by the federal government.

She replied that the bill exempts an estimated "95 percent of small businesses" from providing health insurance while enabling their employees to purchase it on a public exchange. She said that the administrative costs of such insurance will come out of premiums, rather than from federal funds.
"No longer will people be job-locked because for lack of another way to get health coverage," she said, calling health costs "the biggest chain and anvil around the entreprenurial spirit."

Rep. Holt called House passage of the bill, "the largest step yet in history toward providing quality medical care to all Americans" and expressed confidence that the White House would favor key elements of the bill as it moves to the Senate and into conference committee. Citing the state of the nation's current system as making the case for reform, Holt said Americans are "living sicker, dying young and paying more for health care than any of us would want."



The two Democrats briefly toured the medical enter at Princeton, a 308-bed acute care hospital which is part of the Princeton Health Care System and is in the process of building a new home in nearby Plainsboro.

Insurance, cost control, medical information technology

health insurance

Thoughts on health insurance: Various insurance policies can insure you against different levels of health care needs from catastrophic-only needs to comprehensive health care needs. Policies are so complex that few people buying them feel comfortable comparing one policy against another. Few people I talk to have the knowledge to understand the many types of serious and even rare medical conditions they or their family members might get or the potential costs they could encounter if they got such a diagnosis. Making clear standards for health care insurance coverage would help people compare policies and choose what risks they can bear in exchange for lower cost policies.

The fact that medical costs are the cause of over 50 percent of U.S. bankruptcies indicates that many people had no idea of the potential costs of serious medical conditions and were either uninsured or underinsured. This argument comes up in discussing allowing insurers to sell insurance across state lines. Many states have specific health care coverage standards to ensure people get coverage for the most serious and costly unexpected needs while other states do not.

Where health care dollars go: Health insurance is based on 5-6 people paying into a fund so that 1 person who needs a lot of care can pay for it and the others can be glad their health care costs are minimal. Given that people cannot readily predict who will get serious medical illnesses or conditions, when you buy a policy, you hope you won't really need high-cost services but you buy it to cover the possibility you may be the one to need it. The statistics show that 85 percent of health care costs are needed by a very small 15-20 percent of the population who get very serious acute or chronic medical conditions like cancer, severe heart disease, diabetes, stroke, severe accidental trauma, and rare diseases like multiple sclerosis, kidney failure needing dialysis or kidney transplant, etc. The rest of the people use the remaining 15 percent of health care dollars for preventive and intermittent acute medical care. As the possible treatments for diseases have grown, high-cost pharmaceutical therapies, more detailed and expensive diagnostic tests, complex surgical interventions, high-tech radiation treatments, and growing sub-specialty care have all grown in a system that rewards doing more without having to show that more is better. In addition, despite being the country at the heart of high-tech innovation, we are just now investing in the health IT that will better allow us to fully report and analyze how our various medical interventions impact people's survival, quality of life and length of life.

Does controlling or lowering costs mean rationing? To ensure our businesses remain competitive in a global economy, we need to keep people healthy and do it cost effectively. The continuing rise in every aspect of health care above the economy's growth is unsustainable. Studies, such as the Dartmouth Atlas Study, and studies from other countries with universal access to health care show that Americans pay 2-3 times as much for medical care without improvements in our health. That is sobering as most of us would not pay unnecessarily for any product that did not provide a benefit to us. Without detailed access and reporting on health outcomes, patients and health care providers have not had immediate access to the best information to make decisions with. We have studies to show what works and what does not work for many common and serious diseases, but getting this accurate information to patients and their providers has been challenging before the Internet age. We have many studies showing that many people don't get standard therapies that are known to provide the best outcomes and many others get unnecessary and risky tests, treatments and procedures that don't improve their health. Experts and some model medical clinics have shown that we can expect to save at least 30 percent of our health care costs if we gave better care to people, especially those with chronic medical conditions like diabetes, heart disease, high blood pressure, obesity, mental illnesses and prevention for obesity, diabetes, many infections and certain cancers.

When we talk about spending our dollars wisely, this does not require rationing or threatened death panels, but instead requires a common sense approach to ensuring that people get the best proven, coordinated medical care in a timely manner to minimize suffering and disease. We also need to address dollars spent which do not improve our health such as excessive executive salaries, unnecessary health care overhead for paperwork and arguing between insurers and providers, as well as unnecessary testing and legal costs for defensive medicine. Competition is the American way to bring transparency and cost reductions to our market place. Increasing competition with products we can all clearly evaluate can ensure we get the best value for our health care dollar.

Personal medical health information technology could help us lower costs and improve care: With the expansion of health care IT with electronic health records at hospitals, doctor offices, clinics and even Web-based health records available through Google Health and Microsoft Health which will be controlled by individual patients, many more opportunities for each of us to get reliable advice on health improvements are possible, direct to our inboxes! People can monitor their medical, dental, eye and other health care, decide who of their doctors or hospitals or family members have access to which of their health information. The doctors and health care providers can study and advise people by phone, e-mail, send specific information and recommendations tailored to each patient with a goal of improving their total health and not just focusing on one problem in isolation.

America needs a real health care debate

health insurance

America wants and needs a debate about health care in the worst way. It's sad to say that's exactly the manner in which the U.S. Senate is going about it.

The so-called "World's Greatest Deliberative Body" may not even take up one of the nation's most pressing domestic issues if Majority Leader Henry Reid can't muster 60 votes this week to override a potential filibuster. That whirring noise you hear? That would be George Washington, John Adams and Thomas Jefferson spinning in their graves.

Here's what the Senate should be debating this week: Do Americans have a right to health care insurance, and if so, how does the nation pay for it? Will the current proposals offered by the Senate and the House lower or raise health care insurance premiums? And most important of all, how can the United States regain control of skyrocketing medical costs without curbing the world's greatest medical innovators?

Instead, Americans can expect to hear explanations of the term "cloture," along with weak explanations of why a minority of senators can hold up proceedings on bills of national importance. And even if the Senate does override a filibuster and begin deliberating on health care, the topics most likely to dominate the hearing are abortion, immigration and what appears to be a very watered-down version of the public option.

This failure to focus on the key issues wouldn't matter so much if maintaining the status quo were a reasonable option. But more than 50 million Americans are uninsured, including nearly 200,000 in one of the nation's wealthiest counties — Santa Clara County.

The United States spent $2.4 trillion, or roughly 15 percent of GDP, on health care in 2008, 50 percent more per capita than any other industrialized nation. Spiraling health care costs remain near the top of the list of concerns for the business community, including Silicon Valley. And more than 60 percent of the 1.5 million Americans who filed for bankruptcy in the past year did so because they couldn't pay their medical bills. The majority of them were homeowners and members of the middle class.

The failure to enact health insurance reform must not be an option for Democrats in the Senate. But moderate Democratic Sens. Blanche Lincoln, Evan Bayh, Mary Landrieu and Ben Nelson are lining up with Independent Sen. Joe Lieberman and Republicans to prevent the debate from even starting by mounting a filibuster.

Nelson wants an anti-abortion provision included in the bills being discussed. He's also joining the others in attempts to kill or water down a public option to compete with private insurance companies.

Reid needs to remind senators what's at stake. The list of presidents who have tried to reform health care reads like a who's who in American politics. The House's approval of a bill was the first of its nature in 50 years, and if the Senate effort fails, and history is any guide, it may be years before Congress gets this close again.

This week, the Senate could present one of the most important debates of the last century. It must not let this historic opportunity slip away.

Obama’s Malpractice

medical insurance plans

There is an air of absurdity to what is mistakenly called "health-care reform." Everyone knows that the United States faces massive governmental budget deficits as far as calculators can project, driven heavily by an aging population and uncontrolled health costs. Recovering slowly from a devastating recession, it's widely agreed that, though deficits should not be cut abruptly (lest the economy resume its slump), a prudent society would embark on long-term policies to control health costs, reduce government spending, and curb massive future deficits. The president and his top economic advisers all say this. (Click here to follow Robert J. Samuelson ).

So, what do they do? Just the opposite. Their sweeping overhaul of the health-care system—which Congress is halfway toward enacting—would almost certainly make matters worse. It would create new, open-ended medical entitlements that would probably expand deficits and do little to suppress surging health costs. The disconnect between what Obama says and what he's doing is so glaring that most people could not abide it. The president and his allies have no trouble. But reconciling blatantly contradictory objectives requires them to engage in willful self-deception, public dishonesty, or both.

The campaign to pass Obama's health-care plan has assumed a false, though understandable, cloak of moral superiority. It's understandable because almost everyone thinks that people in need of essential medical care should get it; ideally, everyone would have health insurance. The pursuit of these worthy goals can easily be projected as a high-minded exercise in the public good.

It is false for two reasons. First, the country has other goals—including preventing future financial crises and minimizing the crushing effects of high deficits or taxes on the economy and younger Americans—that "health-care reform" would jeopardize. And second, the benefits of "reform" are exaggerated. Sure, many Americans would feel less fearful about losing insurance; but there are cheaper ways to limit insecurity. Meanwhile, improvements in health for today's uninsured would be modest. They already receive substantial medical care; insurance would help some individuals enormously, but studies find that, on average, gains are moderate.

The pretense of moral superiority dissolves before all the expedient deceptions used to sell the health-care agenda. Obama says he won't sign legislation that adds to the deficit. One way to do this is to put costs outside the legislation. So: doctors have long complained that their Medicare reimbursements are too low; the fix for replacing the present formula would cost $210 billion over a decade, says the Congressional Budget Office. That cost was originally in the legislation. Now it's been moved to another bill, but because there are no means to pay for it, deficits would increase.

Another way to disguise the costs is to count savings that, though they exist on paper, would probably never be realized in practice. The House bill claims reductions in Medicare reimbursements of $228 billion over a decade for hospitals and other providers. But Congress has often prescribed reimbursement cuts that, under pressure from providers, it's later rescinded. Claims of "fiscal responsibility" for the health-care proposals reflect "assumptions that are totally unrealistic based on past history," says David Walker, former U.S. comptroller general and now head of the Peter G. Peterson Foundation.

Equally misleading, Obama's advisers assert that the present proposals would slow the growth of overall national health spending. Outside studies disagree. Three studies (two by the consulting firm the Lewin Group and one by the Centers for Medicare & Medicaid Services, a federal agency) conclude that various congressional plans would increase national health spending compared with no legislation. The studies estimate the extra spending, over the next decade, at $750 billion, $525 billion, and $114 billion, respectively. The reasoning: greater use of the health-care system by the newly insured would overwhelm cost-saving measures ("bundled payments," "comparative effectiveness research," tort reform), which are weak or experimental.

Though these estimates could prove wrong, they are more plausible than the administration's self-serving claims. Its health-care plan is not "comprehensive" because it slights cost control; and if its spending commitments worsened some future budget crisis, it wouldn't qualify as "reform." It would be a self-inflicted wound.

Health Insurance Reform Could Harm Children

medical insurance plans

Concerns over the negative impact of health insurance reform on children have been raised recently by child health and industry advocates. One concern is the possible burden on children’s hospitals because of cuts to hospitals, while another is associated with the repeal of the Children’s Health Insurance Program (CHIP).

Reductions to Children’s Hospitals
The first issue is the $155 billion reduction in federal payments over 10 years which hospital groups agreed to in July. A USA Today (Nov. 6) story reported that the industry’s trade group (National Association of Children’s Hospitals) claims these cuts will have a disproportionate impact on children’s hospitals, resulting in significant reductions in the health services they will be able to provide for children.

The problem is the proposed reduction in federal payments that reimburse hospitals for the care they provide to people who have no health insurance or who are on Medicaid. Children’s hospitals provide services to a greater share of patients on Medicaid than to general hospitals, and Medicaid pays hospitals less than private insurance. Children’s hospitals also have less to gain from an increase in the number of people who will get health insurance under the reform package because most of them already have coverage.

Therefore, hospitals that serve children are lobbying Congress to stop changes to health care that they claim could cost them hundreds of millions of dollars. The industry trade group estimates legislation approved by the Senate Finance Committee would reduce funding to children’s hospitals by $876 million. The bill in the House would cut it by $395 million.

Elimination of CHIP
Elimination of the Children’s Health Insurance Program (CHIP) is another concern. The health reform bill passed by the House vote would repeal CHIP in 2014 and shift some low-income children into the Medicaid program while others would have to go to private plans that could be most costly and guarantee fewer benefits, noted The Washington Independent.

The reform bill passed by the House expands Medicaid eligibility to 150 percent of poverty and then sends all other children who live above that level to private health insurance plans, the so-called exchange mentioned in the reform package. While Medicaid programs are required to offer preventive care (a plan that includes early periodic screening, diagnosis and treatment), the exchange plans do not operate under the same mandate. Thus the families of children who end up with the exchange option will be forced to pay more for less coverage.

Not everyone is behind the drive to end CHIP. Sen. Jay Rockefeller (D-WVa) has sponsored an amendment to reauthorize CHIP through 2019, and members of the Finance Committee passed the amendment last month.

The future of health insurance reform in America is uncertain. For children who have no direct voice in the matter, the fallout of cuts to health insurance coverage and medical care could have a lasting negative impact on the rest of their lives.

Leaving Students Behind: Health Plans Get Failing Grade

medical insurance plans

A recent report on the student health program (SHP) by the Division of Health Care Finance and Policy gives us one of the first detailed looks into student health insurance plans since they were mandated 20 years ago. And it’s not a pretty picture.

Some background: Most students in Massachusetts are required to have health insurance and colleges and universities are required to offer qualified student health insurance plans (QSHIP) that can be purchased by students to meet the state mandate. Only a quarter of students subject to the mandate (about 97,000 people) buy school-based insurance; most waive the school coverage because they have insurance through their parents, a spouse, or an employer.

We’ve always known that the minimum required benefits in student health insurance have some serious gaps, particularly for students who have serious medical problems. The plans were mandated as part of the state’s 1988 health reform law, with a primary purpose of getting students out of the state’s Uncompensated Care Pool. Since the state was mandating coverage, it wanted to keep premiums low, which it did by developing a minimum benefit package that would cover most of the needs of most students but not provide comprehensive coverage.

The minimum standards recognize the goal of making primary and preventive care reasonably available to students by mandating coverage and keeping the maximum annual deductible fairly low ($250). (Most schools have student health services at which students can obtain many primary care services that are financed directly by the schools rather than through insurance.)

But SHIP plans are permitted to impose limitations that are uncommon in most other types of health insurance in the state, including:

–Caps on total benefits per illness or injury of $50,000 (an annual cap of $50,000 is permitted in the state’s Young Adult Plan).
–Annual or per illness/injury limits on specific services. For example, some plans have an outpatient service cap of $1500 or a limit of $5,000 on surgeon’s fees
–No coverage is required for prescription drugs
–Limits on pre-existing conditions for up to 6 months

Many of the school plans also have complicated and high cost-sharing, especially coinsurance, which makes it very difficult for students to understand their potential liability.

Although it’s no surprise that most QSHIP plans have limited benefits, the DHCFP report provides information on the number of students affected by the limitations. For example, in the last three years, a fairly small number of students—92—exceeded the maximum benefit in their QSHIP plan but more than 4,000 students exceeded the outpatient maximums. While the numbers might seem small, students can incur significant medical debt because of these limits. And since one of the primary purposes of insurance is to provide financial protection if we get seriously ill, many QSHIP plans fail this test.

The concern that has always been expressed about improving the minimum QSHIP benefits is that any change would increase premiums, perhaps significantly, for some schools and their students. But the DHCFP report suggests we might be able to have our QSHIP cake and eat it too.

This is because the report shows that QSHIP plans are very profitable for most of the insurers that sell them. The average profit margin is 10%, or $11 per member per month, compared to a profit margin of 2% or $8 pmpm in other types of private health insurance. (The average monthly premium for regular health insurance is $343 compared to $104 for QSHIP). At a profit margin of $11 pmpm, QSHIP plans generate $13 million in profits annually for the insurers that sell them (or $10 million excluding Havard, MIT and Northeastern, which self-insure their student plans and so retain any surplus).

These profits are going mainly to a small number of out-of-state health insurance companies. Four insurers–Aetna, Nationwide, Combined and MEGA– cover 60% of the students (and 82% of the students covered by insured rather than self-funded plans). This contrasts to the rest of the private health insurance market, in which local plans cover most people.

It’s hard to believe that we can’t do much better in providing decent health coverage to students at an afforable price. In addition to reducing profits, there are probably also real opportunities to decrease the 20% of premium that goes to administrative expenses (including broker commissions). The Connector, of which I am a board member, seems a logical agency to take the lead on developing new insurance products for students, working in partnership with DHCFP, which oversees the SHP in the state, and the Division of Insurance, which is responsible for overseeing insurance companies licensed in the state.

Students were the first group to be required to have health insurance in Massachusetts, but ironically, we’ve left them behind in our most recent health reform efforts. The DHCFP is to be commended for taking this hard and public look at the SHP program. Now it’s time for action.

Pingree has hope for insurance reform

individual health insurance

More than once in recent months, as the debate swirls around how best to reform the nation's health care system, U.S. Rep. Chellie Pingree has been asked, "So, what do you think the Senate is going to do?"

Her stock response: "You know, I'm in the House."

Defensive? Maybe a little.

Still, with all eyes on what role Maine Republican Sens. Olympia Snowe and Susan Collins may (or may not) play in the final forging of a health reform package, Maine's 1st District congresswoman hasn't exactly been wallowing in headlines these days.

So, lest we forget that there are two sides to the U.S. Capitol, here's one: "Pingree urges Senate to get moving."

"I'm just afraid that the more we put it off without a deadline, Jan. 1 becomes March 1 becomes we're on our summer recess -- and then we could never come to an agreement," Pingree said last week. By now, she added, "we really know what the major issues are."

Starting, of course, with the "public option." Declared dead on arrival only a few months ago, it's back -- both in the House bill and, with an opt-out for individual states attached, in the Senate bill now being hammered out by Senate Majority Leader Harry Reid.

And while Snowe and Collins promise they won't vote for a government-run program aimed at keeping private insurance rates affordable, Pingree can't envision supporting final legislation without one.

To Pingree, it's a no-brainer: Currently, she notes, Anthem Blue Cross Blue Shield accounts for 78 percent of Maine's insurance market.

Meanwhile, Anthem is suing state Insurance Superintendent Mila Kofman over the break-even, 10.9-percent rate increase she approved earlier this year for the company's 12,000 individual insurance policies. Anthem wants an 18 percent increase, which would guarantee a 3 percent profit on those policies.

"If we don't have a public option and we continue what we have in Maine, where one company owns 78 percent of the market, I don't see how you make it affordable," Pingree said. "And I'm going to feel kind of guilty saying to people, 'OK, I just signed onto a bill that requires everybody to be in the system -- but I have no way of controlling costs and you're still at the mercy of the insurance companies.' That's what I worry about."

There's no question Pingree has support for her position: Upon returning to Portland from Washington, D.C., last weekend, she was greeted by a group of supporters holding signs that said "Thank You" for supporting the House bill.

And in a poll of 401 Mainers last month, Pan Atlantic Strategic Marketing Services asked, "Would you favor or oppose the government offering everyone a government administered health insurance plan -- something like the Medicare coverage that people 65 and older get -- that would compete with private health insurance plans?"

Just over 57 percent of the respondents said they would.

Hence, Pingree said, "I feel comfortable that my constituency sees this the way I do."

But what about those who rail against the public option as the end of democracy as we know it?

"We get plenty of complaints from people who say the public option is socialism and don't let the commies take over America," Pingree said. "But you can kind of tell that tends to be a little bit more (talk radio host) Glenn Beck-driven."

That said, the days leading up to the House's 220-215 vote in favor of its health bill was an education of sorts for Pingree on the perils of the political curve ball. She voted against the amendment by fellow Democratic Rep. Bart Stupak of Michigan banning coverage of abortion by private policies that receive federal tax credits, but still voted for the final bill after the amendment prevailed.

(Maine 2nd District Rep. Michael Michaud, on the other hand, voted for both the amendment and the final bill, which he called "a good step forward.")

"If you asked me two weeks ago, I'd have said I'm never voting for a bill (that prohibits private insurance plans from covering abortion)," Pingree said. "And in the end I voted for final passage -- even though I voted no on the amendment."

So, might the same thing happen if the legislation that comes out of a House-Senate conference contains no public option? What if Snowe's so-called "trigger" -- in which a government-run plan kicks in only after private insurers fail to meet affordability benchmarks -- emerges as the ultimate compromise?

"It will depend on what the total bill looks like," Pingree said. "If there was a trigger option, I would need to know it was so tight that it really would force immediate behavior changes by the insurance companies that would happen rapidly. It couldn't be just the hypothetical, 'Hey, if you don't behave we're going to slap your wrists down the road, so be nice guys.'"

But the important thing right now, Pingree said, is for the Senate to pick up the pace and put a final bill on the table. The longer that takes, she said, the easier it will be for the insurance lobby and other special interests to launch another barrage of "myths and lies and untruths" that flooded the airwaves during the congressional recess in August.

"The big picture is that we have to get everybody into the health care system," Pingree said. "Because if you don't have good, preventative care and everybody doesn't get some form of basic insurance, you can't keep people healthier, you can't bring down costs. It just doesn't work."