As the health care debate raged onwards in 2009, the number of uninsured American adults rose by 3 million from 2008. Overall, approximately 46.3 million people in this country do not have health insurance covered.  In Texas, over one out of every four people was uninsured in 2009, compared to the 15.4 percent nationally.

The Center for Disease Control (CDC) survey found that almost 60 million people went without health insurance for at least part of the year, and 33 million of the uninsured had gone without for over a year.  People who were fortunate to keep their private coverage ended up paying more, while high-deductible plans also grew in popularity—especially among people who purchase their own health insurance plans.

3 Million More Uninsured in 2009

Fewer children are going without health insurance plans because they are enrolled in public policies.  See my previous article onCHIP and enrollment strategies the government may be using to get more kids into the program. However, almost one third of Americans between the ages of 18 and 24 did not have health insurance, the highest percentage of any other age group. Still, the fact that the ranks of the uninsured actually expanded in 2009 are worrisome to me.

Although individuals can still pay out of pocket for services, health insurance remains the most crucial portal to receiving adequate health care.  People who are enrolled in health insurance plans, regardless of the level of coverage, have far more access to preventative medical services. There is no denying that adequate medical care is expensive—rising medical costs in addition to the economy make insurance critical to obtaining health services.  If you are uninsured, you are more apt to delay health care until your illness is severe. According to research by the Harvard Medical School, around 45,000 Americans die every year because they are uninsured and therefore cannot receive adequate health care.

This study highlights the importance of health insurance in the United States today.  For the most part, people without health insurance are more likely to have lower incomes, and face an uphill battle when it comes to paying for care out of pocket.  Increasing rates of uninsured Americans is undoubtedly linked to the recession, which keeps them away from receiving the care they need. The fact that so many Americans remain uninsured—whether by choice or by economic necessity—proves very relevant to the 2010 Affordable Care Act. Escalating rates of un-insurance and skyrocketing medical costs are huge problems in the United States today.

When 2014 rolls around, enrolling the uninsured in new health insurance plans will be a daunting task.  The Affordable Care Act will broaden insurance to over 30 million citizens, who will likely need a little prodding when it comes time to enroll.  Canvassing campaigns in low-income neighborhoods aim at enrolling uninsured children in CHIP or Medicaid,working as a test run for the 2014 expansion of health insurance coverage.

As in my last blog about Massachusetts Health Care Reform, it is not the broader coverage that I am concerned about. Hopefully, the government will take cues from Massachusetts and ensure that the reform will not grow so costly that expenses outweigh coverage benefits.

36 Arrested in Medicare Fraud Sting

In the most peculiar of these operations, a medical center in Brooklyn scammed $72 million from Medicare by submitting bogus charges for physical therapy for elderly Russian immigrants. Patients who sold the office their Medicare numbers were paid by a man in a back-room who did nothing but bribe patients all day. Authorities say the “kick back room” was decorated with posters resembling Russian propaganda, which read in Russian “Don’t Gossip” and “Be on the lookout: In these days, the walls talk.”

Sebelius and Holder commented at the healthcare fraud prevention summit in Miami that these busts are an important step toward conquering the larger problem of fraud which has seriously impacted the system in recent years. Lately, schemes have become more sophisticated. In the past, fraudsters (usually clinic owners) would bill Medicare multiple times for the same piece of medical equipment which no patient ever received. Today, schemes involve a more complex web of doctors, patients, clinic owners, and sometimes violent criminals. Mobsters and violent offenders have started getting in on the Medicare fraud action because they find it more lucrative and with less severe criminal penalties than other offenses like drug or gun trafficking.

Eliminating an estimated $60-90 billion per year in Medicare fraud is a key component of President Obama’s plan to pay for healthcare reform. In order to accomplish this, federal authorities have promised more man power and funding and are using new technologies to keep up with criminals. It used to take ninety days before the feds detected a scam, by which point criminals had usually slipped away with millions of dollars. Now, authorities monitor billing data in real time allows them to catch a scam almost immediately.

The most problematic area for authorities continues to be Miami, which has long been the epicenter of Medicare-related fraud. For example, according to a federal report Miami-Dade county received about $520 million from Medicare in home health payments in 2008. That’s more than the rest of the country received combined, even though Miami-Dade contains just 2% of patients eligible for those benefits. In 2007, authorities launched a strike force in the area to address this growing problem. The program which started there has expanded to seven cities around the country and has resulted in over 720 indictments for those who’ve defrauded Medicare for more than $1.6 billion.

Entitlement Reform: What happens when Medicare and Social Security Are Bankrupt?

This threat has been looming in the background for years, and though successive administrations have “kicked the can” down the road we must confront the fact that the financial health of our two major entitlement programs has withered more during this recession than at any time since the mid-1990s. Though the economic downturn has contributed significantly to the programs’ rate of decline given the fact that worsening unemployment figures mean fewer workers are paying into the trusts’ funds through payroll taxes, the pressure of baby-boomers aging into the programs has pushed their financial health to the breaking point independent of current economic conditions.

These facts point glaringly to the need for entitlement reform. Obama administration officials have suggested that if the legislature were to act the programs’ insolvency could be bridged in three ways: by raising workers’ Social Security payroll taxes by 2 percentage points, by reducing benefits by 13 percent, or by a combination of the two.

Electronic Medical Records On the Rise

Doctors are notorious for their messy, often illegible handwriting that can often produce doctor errors.  One optometrist, Meera Sutaria, reported that investing in such technology increased her office’s efficiency.  Because there were fewer issues with paperwork, Sutaria was able to spend more quality time with patients. Computerized records save paper, and make it easier for other doctors to read and access patient information, especially in the emergency room, where doctors often have limited access to patient information.  One Wisconsin doctor, Dr. Ashok Rai, has waited for hours just to receive faxes for his out-of-network E.R. patients, which could easily have been avoided had other doctors outside his hospital made use of electronic records.

Proponents of EMRs point to the reduction of paperwork and increased readability as a great way to streamline and manage healthcare. In a world where health care costs are exploding, saving money is incredibly important.  Kaiser Permanente, a company that revolutionized medical records, found that computerized records helped track vaccine safety in a study of young children. In this society, where patients can be seeing multiple doctors and specialists, it is necessary to have a way to quickly share information with other providers.  Electronic medical records can improve quality of care for patients, ensuring that they do not undergo duplicate or unnecessary procedures. Plus, electronic medical records might be able to streamline the insurance claims process, paying doctors instantly in real time.

Not all doctors or hospitals make use of computerized records today.  In fact, electronic medical records are in the minority rather than the majority.  Providers who do use such medical technology may use it in different ways or to different extents. However, I feel that an expanded, unified system will truly be able to streamline care if (and only if) it is executed properly.

Opponents of Health IT argue that the shift from paper to computer may actually result in higher costs. Providers may charge patients to afford new health information technology. Other providers, including Kaiser Permanente—a Health IT leader—fear that they won’t qualify for subsidies under the government’s new meaningful care standard, which may be too strict to start off with. However, so long as the government places guidelines that ensure high quality of care for patients, poor quality can be avoided.  Servers and databases must be guaranteed secure in order to prevent hacking and identity theft.

Ultimately, I feel that widespread adoption of electronic medical records will only be helpful for the health care industry. First of all, the government must ensure the safety of patients’ personal information. And providers need to step up their efforts in modernizing now so that they can benefit from the subsidies.

Unfortunately last fall a group known as the National Quality Forum, rejected the call for a scan 45 minutes after a stroke wording that the rule to do so would raise too many questions. The cost for such scans is one of the main reasons the stroke treatment was rejected. The Obama administration is trying to cut healthcare costs and this procedure is considered costly and unnecessary.

On the other hand, stroke neurologists are angry by the decision to reject this procedure. They believe that the rejection threatens to compromise stroke care all over the country which can possibly result in more deaths among stroke patients.

Kathleen Sebelius is currently serving as the 44^th Governor of Kansas and the second female governor of Kansas. She was first elected to the Kansas House of Representatives back in 1986 and left the House in 1994 to run for state insurance commissioner. She was elected to the position of Governor in 2002 and was reelected again in 2006. She has been named one of the best governors in America according to Time Magazine in 2005 for eliminating the $1.1 billion debt she had inherited when elected to governor.

Senator Max Baucus of Montana says, “I’m particularly pleased to hear of her selection because she brings such solid experience to the position. Passing comprehensive health-care reform is an absolute imperative this year, and as a former insurance commissioner, Governor Sebelius really gets what needs to be done.”

As the Secretary of Health and Human Services, Sebelius will take charge of an agency with 65,000 employees responsible for the public health, food safety, scientific research, and the administration of the Medicare and Medicaid programs of 90 million Americans.